Multifactorial Shock: A Neglected Situation in Polytrauma Patients

Abstract

Background: Shock after traumatic injury is likely to be hypovolemic, but different types of shock (distributive shock, obstructive shock, or cardiogenic shock) can occur in combination, known as multifactorial shock. Multifactorial shock is a neglected area of study, and is only reported sporadically. Little is known about the incidence, characteristics, and outcomes of multifactorial shock after polytrauma. Methods: A retrospective, observational, multicenter study was conducted in four Level I trauma centers involving 1051 polytrauma patients from June 2020 to April 2022. Results: The mean Injury Severity Score (ISS) was 31.1, indicating a severely injured population. The most common type of shock in the early phase after polytrauma (≤48 h) is hypovolemic shock (83.2%), followed by distributive shock (14.4%), obstructive shock (8.7%), and cardiogenic shock (3.8%). In the middle phase after polytrauma (>48 h or ≤14 days), the most common type of shock is distributive shock (70.7%), followed by hypovolemic shock (27.2%), obstructive shock (9.9%), and cardiogenic shock (7.2%). Multifactorial shock accounted for 9.7% of the entire shock population in the early phase and 15.2% in the middle phase. In total, seven combinations of multifactorial shock were described. Patients with multifactorial shock have a significantly higher complication rate and mortality than those with single-factor shock. Conclusions: This study characterizes the incidence of various types of shock in different phases after polytrauma and emphasizes that different types of shock can occur simultaneously or sequentially in polytrauma patients. Multifactorial shock has a relatively high incidence and mortality in polytrauma patients, and trauma specialists should be alert to the possibility of their occurrence.

A B C Dengue: a case of multifactorial shock due to major trauma and dengue infection

“…The differential diagnoses of shock during the acute and perioperative phase of major trauma in the context of this case were broad and multifactorial, including ongoing haemorrhage, sepsis due to intraabdominal collections or nosocomial pneumonia, systemic in ammatory response syndrome, fat embolism and concurrent infections (3).…”

Airway breathing circulation dengue: a case of multifactorial shock due to major trauma and severe dengue infection

“…The differential diagnoses of shock during the acute and perioperative phase of major trauma in the context of this case were broad and multifactorial, including ongoing haemorrhage, sepsis due to intraabdominal collections or nosocomial pneumonia, systemic inflammatory response syndrome, Disseminated Intravascular Coagulopathy, fat embolism and concurrent infections [ 3 ]. In this instance, the patient developed DSS complicated by multiorgan dysfunction and sepsis which complicated her recovery.…”

A Critical Care Echocardiography—Driven Approach to Undifferentiated Shock

“…Each of the 4 types of shock can be present singularly or in combination at any time in critical illnesses. 1 , 2 Therefore, initial and subsequent hemodynamic monitoring at the bedside is necessary to guide the appropriate management of shock. Although they have their limitations, noninvasive measures of hemodynamic parameters, such as stroke volume and cardiac output, can help establish the nature of the shock, particularly when assessing patients in acute care settings.…”