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PLoS One. 2017 Apr 27;12(4):e0176587. doi: 10.1371/journal.pone.0176587. eCollection 2017.

Vasopressor use following traumatic injury - A single center retrospective study.

Author information

1
Division of General Surgery, Université de Sherbrooke, Sherbrooke, Québec, Canada.
2
Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
3
Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Québec, Canada.
4
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada.
5
Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada.
6
Department of Anesthesiology and Critical Care, Université Laval, Québec, Québec, Canada.
7
Centre de recherche du Centre hospitalier universitaire de Québec, Québec, Québec, Canada.
8
Department of Medicine, Université Laval, Québec, Québec, Canada.
9
Department of Critical Care, Université de Montréal, Montréal, Québec, Canada.
10
Centre de recherche de l'hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.
11
Department of General Surgery, Université Laval, Québec, Québec, Canada.
12
Department of General Surgery/Trauma Surgery, MUHC Montreal General Hospital, Montreal, Quebec, Canada.
13
Department of Physiatry, Université de Montréal, Montréal, Québec, Canada.
14
Centre de recherche du Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada.
15
Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, Québec, Canada.
16
Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada.
17
Division of Traumatology/General Surgery, Sacré-Coeur Hospital of Montreal, Montreal, Canada.
18
Department of Urology, Université de Sherbrooke, Sherbrooke, Québec, Canada.

Abstract

OBJECTIVES:

Vasopressors are not recommended by current trauma guidelines, but recent reports indicate that they are commonly used. We aimed to describe the early hemodynamic management of trauma patients outside densely populated urban centers.

METHODS:

We conducted a single-center retrospective cohort study in a Canadian regional trauma center. All adult patients treated for traumatic injury in 2013 who died within 24 hours of admission or were transferred to the intensive care unit were included. A systolic blood pressure <90 mmHg, a mean arterial pressure <60 mmHg, the use of vasopressors or ≥2 L of intravenous fluids defined hemodynamic instability. Main outcome measures were use of intravenous fluids and vasopressors prior to surgical or endovascular management.

RESULTS:

Of 111 eligible patients, 63 met our criteria for hemodynamic instability. Of these, 60 (95%) had sustained blunt injury and 22 (35%) had concomitant severe traumatic brain injury. The subgroup of patients referred from a primary or secondary hospital (20 of 63, 32%) had significantly longer transport times (243 vs. 61 min, p<0.01). Vasopressors, used in 26 patients (41%), were independently associated with severe traumatic brain injury (odds ratio 10.2, 95% CI 2.7-38.5).

CONCLUSIONS:

In this cohort, most trauma patients had suffered multiple blunt injuries. Patients were likely to receive vasopressors during the early phase of trauma care, particularly if they exhibited signs of neurologic injury. While these results may be context-specific, determining the risk-benefit trade-offs of fluid resuscitation, vasopressors and permissive hypotension in specific patients subgroups constitutes a priority for trauma research going forwards.

PMID:
28448605
PMCID:
PMC5407798
DOI:
10.1371/journal.pone.0176587
[Indexed for MEDLINE]
Free PMC Article

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