Analysis of metabolic parameters predicting outcome in polytrauma patients

Saravanan, S K (2016) Analysis of metabolic parameters predicting outcome in polytrauma patients. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Polytrauma remains an important public health problem because of high mortality and morbidity. While the need for lifesaving surgeries and to tackle the complications preventing mortality and morbidity is addressed, an importance of measuring important metabolic parameters predicting the outcome in such patients is often neglected. By predicting the outcome, especially in the normotensive individuals, we could prevent unforeseen complications by intensely resuscitating the patients. AIM OF THE STUDY: The main objective of our study is to analyze the significance of vital parameters, basic blood investigations and serum lactate at the time of admission and at serial intervals in predicting the final outcome of the patient. We mainly emphasize our study on significance of serum lactate values and lactate clearance on predicting mortality and complications, at the same time detecting occult hypoperfusion in apparently normal patients. MATERIALS AND METHODS: The study is a prospective observational and analytical study conducted in Madras Medical College & Rajiv Gandhi Govt. General Hospital, Chennai from the period of Mar’2015 to Sep’2015 after getting institution’s ethics committee approval. We included multiply injured patients with injury severity score more than 16 and compound lower limb injury patients of age more than 14 in our study. We recorded vital parameters at the time of admission and at serial intervals. All basic blood investigations and serial serum lactate were measured. Patients managed as per existing standard protocol, lifesaving emergency procedures, complications managed and any elective or reconstructive procedures needed were planned and done. The need for ventilatory support, ICU stay, blood transfusions, length of hospital stay, complications encountered, emergency and elective procedures done and the final outcome of the patient were recorded and analyzed with all initially said parameters using statistical package. RESULTS: Of the total 69 patients we analyzed, 29 patients had early recovery without any major complications, the mean ISS of whom was 15.20, mean SBP at arrival was 103.84, the mean serum lactate level at admission was 25.61mg/dl and lactate clearance of 13.023mg/dl/24hrs. 4 patients of mean ISS 41.67, mean SBP 90.67, mean serum lactate 75.27mg/dl and mean lactate clearance 2.91mg/dl/24hrs died. Thus, the associations of ISS, SBP, serum lactate at admission and lactate clearance with the Patients’ final outcome were found to be significant. The correlation of ISS with serum lactate value at admission was checked which was also significant. DISCUSSION: In our study we found significant correlation between injury severity score (p 0.001), SBP (p 0.003), other basic vital and blood parameters, serum lactate values at admission (p 0.001) and at serial intervals and lactate clearance (p 0.025) with the mortality and other outcome measures like need of ventilatory support, length of ICU & hospital stay, blood transfusions and complications encountered. The trauma scoring systems were also found correlating with serum lactate value at admission (p 0.001). Literature supports our finding. The extra edge of serum lactate in predicting the ongoing occult hypoperfusion in apparently healthy individuals with normal SBP and ISS is clearly seen in our study. CONCLUSION: We conclude that serum lactate and lactate clearance are very good predictors of the final outcome in polytrauma patients and of the ongoing occult hypoperfusion in normotensive individuals. Thus, it will be a valid marker to decide on the end point of resuscitation in multiply injured patients. The extension of this study will be to analyze the importance of serum lactate in deciding on implementation of damage control vs early total care.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Polytrauma, Serum Lactate, Lactate clearance, occult hypoperfusion, SBP, ISS.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 13:44
Last Modified: 16 Sep 2017 13:44
URI: http://repository-tnmgrmu.ac.in/id/eprint/3186

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