Critical care ultrasound in geriatric trauma resuscitation leads to decreased fluid administration and ventilator days

Abstract

BACKGROUND:Geriatric trauma populations respond differently than younger trauma populations. Critical care ultrasound (CCUS) can guide resuscitation, and it has been shown to decrease intravenous fluid (IVF), lower time until operation, and lower mortality in trauma. Critical care ultrasound-guided resuscitation has not yet been studied in geriatric trauma. We hypothesized that incorporation of CCUS would decrease amount of IVF administered, decrease time to initiation of vasopressors, and decrease end organ dysfunction. METHODS:A PRE-CCUS geriatric trauma group between January 2015 and October 2016 was resuscitated per standard practice. A POST-CCUS group between January 2017 and December 2018 was resuscitated based on CCUS performed by trained intensivist upon admission to the intensive care unit and 6 hours after initial ultrasound. The PRE-CCUS and POST-CCUS groups underwent propensity score matching, yielding 60 enrollees in each arm. Retrospective review was conducted for demographics, clinical outcomes, and primary endpoints, including amount of IVF in the first 48 hours, duration to initiation of vasopressor use, and end organ dysfunction. Wilcoxon two-sample, χ 2 tests, and κ statistics were performed to check associations between groups. RESULTS:There was no statistical difference between PRE-CCUS and POST-CCUS demographics and Injury Severity Scores. Intravenous fluid within 48 hours decreased from median [interquartile range] of 4941 mL [4019 mL] in the PRE-CCUS to 2633 mL [3671 mL] in the POST-CCUS (p = 0.0003). There was no significant difference between the two groups in time to initiation of vasopressors, vasopressor duration, lactate clearance, intensive care unit length of stay, or hospital length of stay. There was a significant decrease in ventilator days, with 26.7% PRE-CCUS with ventilation longer than 2 days, and only 6.7% POST-CCUS requiring ventilation longer than 2 days (p = 0.0033). CONCLUSION:Critical care ultrasound can be a useful addition to geriatric resuscitation. The POST-CCUS received less IV fluid and had decreased ventilator days. While mortality, lactate clearance, complications, and hospital stay were not statistically different, there was a perception that CCUS was a useful adjunct for assessing volume status and cardiac function.

Impact of Optimizing the Emergency Care Process on the Emergency Effect and Prognosis of Patients with Hepatic Encephalopathy

“…Studies [ 18 , 19 ] have shown that the traditional resuscitation care procedures are mainly focused on the rescue after the emergence of the problem, and the prognostic impact of the operations related to the assessment and prognosis of the disease, detailed management, and the interface of the resuscitation process is easily neglected, so there is a high risk of procedural confusion and delayed implementation of care measures in the rescue of HE patients, even if the health care workers are experienced and competent, which makes it difficult to ensure the effectiveness and orderliness of resuscitation. Optimizing the emergency care process means fully mobilizing the role of the nursing staff in the emergency department in the resuscitation procedure, when the emergency department receives the nursing staff to assess the patient's condition and immediately carry out life-saving measures as well as improve the success rate of emergency resuscitation [ 20 ].…”