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Blunt trauma resuscitation: the old can respond
B A McKinley1, R G Marvin, C S Cocanour
1Department of Anesthesiology, University of Texas-Houston Medical School, 77030, USA. bmckinle@anes1.med.uth.tmc.edu
Archives of Surgery (Chicago, Ill. : 1960)
|June 8, 2000
Summary
Elderly trauma patients show a hyperdynamic response during shock resuscitation, achieving target oxygen delivery. Despite poorer outcomes than younger patients, their resuscitation is not futile.
Area of Science:
- Trauma critical care
- Geriatric emergency medicine
- Resuscitation science
Background:
- Standardized shock resuscitation protocols aim to optimize oxygen delivery.
- Age significantly impacts physiological responses to trauma and resuscitation.
Purpose of the Study:
- To compare the hyperdynamic response and outcomes of elderly and young trauma patients during standardized shock resuscitation.
- To evaluate the efficacy of a standardized resuscitation protocol in achieving target oxygen delivery in different age groups.
Main Methods:
- An inception cohort study compared old (>=65 years) and young (<65 years) trauma patients.
- A standardized protocol aimed to maintain an oxygen delivery index (DO2I) >= 600 mL/min/m2 for 24 hours.
- Data on interventions, responses, and outcomes (ICU length of stay, survival) were analyzed.
Main Results:
- Elderly patients had lower initial cardiac index but achieved the DO2I goal (75% vs 83% in young).
- Survival rates at 30 days were lower in the elderly (42% vs 89% in young).
- ICU length of stay was similar between groups (25 days vs 23 days).
Conclusions:
- Elderly trauma patients exhibit a hyperdynamic response during resuscitation, despite initial lower cardiac output.
- While ultimate outcomes are poorer, resuscitation efforts in the elderly are not futile.
- Standardized resuscitation protocols can achieve hemodynamic goals across age groups.