Key result
In patients with abdominal injuries and acute blood loss, persisting circulatory hypoxia and low cardiac index at the end of surgery correlated with postoperative lethal outcomes.
Observational (n=50)
In patients with abdominal trauma and massive blood loss, standard intraoperative resuscitation may fail to correct underlying circulatory hypoxia and oxygen debt despite apparent hemodynamic stabilization.
Persisting hypoxia despite resuscitation signals high mortality risk in abdominal trauma; hypothesis-generating for trials targeting cardiac index.
Aim: to analyze the oxygen balance in patients with injuries of abdominal cavity organs and acute blood loss during surgery and arrest of bleeding. Material and methods: the study group consisted of 50 patients (49 men and 1 woman, average age: 33 (25.75; 44.5) years) who experienced injuries of abdominal cavity organs complicated by acute massive blood loss requiring urgent surgical interventions. The severity of patients' state was 38 (27.75; 48) by ISS scoring. The study examined the following parameters: the blood loss volume, hemoglobin (Hg) level, hematocrit (HCT), blood gases, oxygen balance, acid-base balance, electrolyte levels, and the tissue metabolism status. A continuous minimally invasive monitoring of central hemodynamics parameters was performed. The statistical data processing was per- formed using the SPSS software (SPSS Inc., USA). Results: the central hemodynamics parameters did not reflect the severity of patients' state at their admission into an operating room. The signs of hypovolemia were observed along with normal vascular tone and cardiac out- put. At the same time, such parameters of oxygen balance as high VO2I and О2ER, as well as low SvО2 indicated the severity of patients' state. These data demonstrated that patients experienced a severe episode of respiratory or circulatory hypoxia during trauma, which had been corrected during first aid treatment and transportation by patient's admission into the operating room, so patients presented lab test findings of «oxygen debt». The VO2I values remained high in addition to the increase in О2ER values by the end of the surgery. However, low CvO2, PvO2, and SvО2 values indicated the persisting circulatory hypoxia. Conclusion: All patients with postoperative complications were admitted into the operating room with already existing impairment of oxygen delivery. The patients did not recover from shock, the low cardiac efficiency was the main reason for its persistence. The correlation between postoperative lethal outcomes and the value of cardiac index (CI) at the end of surgery in this group of patients was demonstrated.
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Timerbaev et al. (2017) conducted an observational in Injuries of abdominal cavity organs complicated by acute massive blood loss (n=50). Acute massive blood loss and urgent surgical intervention was evaluated on Oxygen balance and central hemodynamics parameters. In patients with abdominal injuries and acute blood loss, persisting circulatory hypoxia and low cardiac index at the end of surgery correlated with postoperative lethal outcomes.
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