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Article Dans Une Revue Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Année : 2023

Femoral blood gas analysis, another tool to assess hemorrhage severity following trauma: an exploratory prospective study

Résumé

Abstract Background Veno-arterial carbon dioxide tension difference (ΔPCO 2 ) and mixed venous oxygen saturation (SvO 2 ) have been shown to be markers of the adequacy between cardiac output and metabolic needs in critical care patients. However, they have hardly been assessed in trauma patients. We hypothesized that femoral ΔPCO 2 (ΔPCO 2 fem ) and SvO 2 (SvO 2 fem ) could predict the need for red blood cell (RBC) transfusion following severe trauma. Methods We conducted a prospective and observational study in a French level I trauma center. Patients admitted to the trauma room following severe trauma with an Injury Severity Score (ISS) > 15, who had arterial and venous femoral catheters inserted were included. ΔPCO 2 fem, SvO 2 fem and arterial blood lactate were measured over the first 24 h of admission. Their abilities to predict the transfusion of at least one pack of RBC (pRBC H6 ) or hemostatic procedure during the first six hours of admission were assessed using receiver operating characteristics curve. Results 59 trauma patients were included in the study. Median ISS was 26 (22–32). 28 patients (47%) received at least one pRBC H6 and 21 patients (35,6%) had a hemostatic procedure performed during the first six hours of admission. At admission, ΔPCO 2 fem was 9.1 ± 6.0 mmHg, SvO 2 fem 61.5 ± 21.6% and blood lactate was 2.7 ± 1.9 mmol/l. ΔPCO 2 fem was significantly higher (11.6 ± 7.1 mmHg vs. 6.8 ± 3.7 mmHg, P = 0.003) and SvO 2 fem was significantly lower (50 ± 23 mmHg vs. 71.8 ± 14.1 mmHg, P < 0.001) in patients who were transfused than in those who were not transfused. Best thresholds to predict pRBC H6 were 8.1 mmHg for ΔPCO 2 fem and 63% for SvO 2 fem . Best thresholds to predict the need for a hemostatic procedure were 5.9 mmHg for ΔPCO 2 fem and 63% for SvO 2 fem . Blood lactate was not predictive of pRBC H6 or the need for a hemostatic procedure. Conclusion In severe trauma patients, ΔPCO 2 fem and SvO 2 fem at admission were predictive for the need of RBC transfusion and hemostatic procedures during the first six hours of management while admission lactate was not. ΔPCO 2 fem and SvO 2 fem appear thus to be more sensitive to blood loss than blood lactate in trauma patients, which might be of importance to early assess the adequation of tissue blood flow with metabolic needs.

Dates et versions

hal-04533017 , version 1 (04-04-2024)

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Marie Werner, Benjamin Bergis, Pierre-Etienne Leblanc, Lucille Wildenberg, Jacques Duranteau, et al.. Femoral blood gas analysis, another tool to assess hemorrhage severity following trauma: an exploratory prospective study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2023, 31 (1), pp.31. ⟨10.1186/s13049-023-01095-9⟩. ⟨hal-04533017⟩
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