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Standardized trauma resuscitation: female hearts respond better
Bruce A McKinley1, Rosemary A Kozar, Christine S Cocanour
1Department of Surgery, University of Texas-Houston Medical School, 6431 Fannin, MSB 4.266, Houston, TX 77030, USA. Bruce.A.McKinley@uth.tmc.edu
Hypothesis:
Women respond better to standardized shock resuscitation compared with similarly severely injured men.
Design:
Severely injured patients who met specific criteria were resuscitated using a standardized protocol with no adjustment for gender. The resuscitation protocol was used to attain and to maintain an oxygen delivery index of 600 mL/min. m(2) or greater (DO(2)I > or = 600) for the first 24 hours in the intensive care unit (ICU). Interventions, responses, and outcomes for the 2 cohorts were compared. Data were analyzed using analysis of variance, chi(2), and t tests; P<.05 was considered significant.
Setting:
A 20-bed regional level I trauma center ICU.
Patients:
Patients at high risk of postinjury multiple organ failure (major organ or vascular injury and/or skeletal fractures, initial arterial base deficit of 6 mEq/L or greater, requirement for 6 units or more of packed red blood cells in the first 12 hours after hospital admission, or age > or = 65 years with any 2 previous criteria).
Interventions:
Pulmonary artery catheter, packed red blood cell transfusion, crystalloid fluid infusion, inotrope, and vasopressor support, as needed, in that sequence, to maintain DO(2)I > or = 600.
Main Outcome Measures:
Hemodynamic response to resuscitation, fluid, and packed red blood cell volume.
Results:
During 2000, 58 patients (38 men, 20 women) met criteria and were resuscitated using our standardized protocol. Demographics and outcomes were similar for both cohorts. Requirements for and responses to standardized resuscitation were also similar, except for volume loading. The female cohort required less lactated Ringer solution volume (12 +/- 1 vs 8 +/- 2 L, P<.05), required less Starling curve intervention (42% vs 15%, P<.05), and maintained the DO(2)I goal with average pulmonary capillary wedge pressure that was less than that of the male cohort.
Conclusion:
Review of prospective data from standardized shock resuscitation for female and male cohorts demonstrates that women respond better to standardized resuscitation compared with similarly severely injured men.