Acid-Base disorders as predictors of early outcomes in major Trauma in a resource limited setting

Abstract

IntroductionMortality from trauma remains a major challenge despite recent substantial improvements in acute trauma care. In trauma care patient resuscitation to correct hypotension from volume loss still majorly relies on use of physiological parameters such as blood pressure, pulse rate, respiratory rate, urine output and oxygen saturation. In resource limited settings these methods may not be sufficient to detect occult tissue hypoxia and the accompanying metabolic derangements.MethodsA prospective observational study carried out at a level I urban Trauma centre; Accident and Emergency unit. Major trauma patients were consecutively recruited into the study. Venous blood samples were drawn for analysis of serum electrolytes, serum PH and anion gap. The venous blood gas findings were correlated with patients’ clinical outcome at two weeks. Ethical approval was obtained.ResultsNinety three major trauma patients were recruited, patients’ age ranged from 12 months to 50 years. Forty nine patients (53%) were acidotic (PH less than 7.32), 39 patients (42%) had low bicarbonate (bicarbonate level less than 21 mmol), 54 patients (58%) had high corrected anion gap (anion gap corrected of 16 or more). Fourteen patients (15%) developed secondary organ failure and 32 (34%) patients died.ConclusionMetabolic acidosis is common among major trauma patients, its severity may be related to delay in initiating care. Acid base derangements were predictors of mortality among major trauma patients in this resource limited setting.

Anion gap as a prognostic tool for risk stratification in critically ill patients – a systematic review and meta-analysis

“…Table 1 illustrates the characteristics of included studies. A majority of studies were conducted in high income countries [ 7 , 8 , 16 – 26 ] while three studies were conducted in middle income countries [ 27 – 29 ] and one in a low income country [ 30 ]. Studies were conducted in the following settings: ICU (10 studies), trauma centre (5 studies), coronary care unit/intensive cardiac care unit (3 studies) and Accident and Emergency department (1 study).…”

“…Studies were conducted in the following settings: ICU (10 studies), trauma centre (5 studies), coronary care unit/intensive cardiac care unit (3 studies) and Accident and Emergency department (1 study). Five studies accounted for the effect of intravenous fluids on AG levels: in one study no patient received more than 400 ml of any intravenous fluid before the AG was measured [ 7 ], in two studies patients receiving more than 250 ml or 500 ml of intravenous fluids respectively were excluded from the analysis [ 16 , 30 ]. Two studies stated that the AG was determined before hospital based management, including intravenous fluids, was initiated [ 21 , 29 ].…”

“…Therefore, other confounders may have accounted for these results. Furthermore, the study by Shane and colleagues [ 30 ] also employed intravenous fluid restriction but found no predictive effect of the AG; however, only mean difference in AG between survivors and non-survivors but not AUC was reported. Further research would be required to determine more conclusively the extent to which the AG is affected by intravenous fluids.…”

Elevated Admission Base Deficit Is Associated with a Complex Dynamic Network of Systemic Inflammation Which Drives Clinical Trajectories in Blunt Trauma Patients

“…On the contrary, BD can quantify the extent of both anaerobic and aerobic acidosis and may be a better clinical indicator for the global assessment of the metabolic acid-base status [32, 39–41]. In addition, prior studies have suggested that elevated arterial BD (≥4 mEq/L) upon admission after injury can be a reliable predictor of multiple organ dysfunction, morbidity, and mortality in moderately/severely injured patients [21, 34, 36, 42–44]. …”

Association between albumin-corrected anion gap and in-hospital mortality of intensive care patients with trauma: A retrospective study based on MIMIC-Ⅲ and Ⅳ databases

“…During the initial stages of trauma, it could be challenging to detect occult shock based on general clinical manifestations and physiological parameters such as heart rate, blood pressure, respiratory rate, and urine volume. Additionally, individuals with hypertension, atherosclerosis or prolonged use of certain cardiovascular medications may exhibit delayed responses to shock [ 3 , 4 ]. Tissue hypoxia and hypoperfusion under shock conditions result in severe metabolic acidosis.…”