Metabolic and perfusion trends in polytrauma patients post-peritoneostomy: identification of risk factors and clinical implications

Circulatory shock secondary to severe trauma is a significant cause of death globally.⁽⁾ Many cases undergo peritoniostomy and the assessment of metabolic and perfusion variables is crucial as early diagnosis of hypoperfusion is a fundamental part of management in these patients.^(,)

Objective:

To analyze perfusion and tissue oxygenation trends in post-peritoneostomy polytraumatized patients, focusing on mortality and seeking to understand the consequences of tissue dysoxia.

Methods:

Prospective longitudinal study in specialized trauma ICUs including severely traumatized adults diagnosed with post-peritoneostomy shock. Palliative patients and deaths prior to ICU admission were excluded. Primary outcomes: metabolic evolution associated with hospital mortality. Secondary outcomes: complications and risk factors for mortality.

Results:

Forty six patients (mean age 31.2±11.4 years; 87% male) with post-peritoneostomy due to severe trauma were analyzed. The majority received more than 10 red blood cell concentrates (90.2%) and tranexamic acid (65.2%). During the first surgery, the median blood transfusion was 7.5 bags (3.75-14.7). All received crystalloids during (median 2250 mL) and in the first 24 hours of ICU (median 3000 mL). The average ICU stay was 12 days, with 4 days of vasopressor use. Hospital complications occurred in 47.8%, with mortality of 26.1%. Non-survivors had a higher ISS (32.7±9.9 versus 26.4±9.9, p=0.05), longer sedation time (7.5 versus 4 days, p=0.037) and vasopressors (8 versus 3 days, p=0.036) as well as a greater volume of crystalloids in the first 24 hours in the ICU (4000 versus 2750 mL, p=0.029). In the multivariate logistic regression analysis, only the time of vasopressor use (OR=1.53; 95%CI=1.02-2.29) and the volume received in the first 24 hours of ICU (OR=1,0005; 95%CI 1,0001-1,001) were independent risk factors for death in this population. Regarding the evolution of metabolic and perfusion variables over time, a significant difference was observed between survivors and non-survivors in lactate (p=0.03). Regarding pH, bicarbonate and urea, significant trends were observed (p<0.1). Creatinine did not differ between groups (p=0.156) (). Regarding coagulation analysis, survivors presented lower APTT and PT values with a statistically significant difference between the groups (p<0.05).

Conclusion:

In this study, we identified that metabolic and perfusion variables are risk factors for mortality in post-peritoneostomy polytraumatized patients. We highlight the importance of monitoring these variables and interventions to improve outcomes for these patients.

Metabolic and perfusion trends in polytrauma patients post-peritoneostomy: identification of risk factors and clinical implications

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