Document Detail


Traditional resuscitative practices fail to resolve metabolic acidosis in morbidly obese patients after severe blunt trauma.
MedLine Citation:
PMID:  20154544     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Obesity is a risk factor for postinjury complications; in particular, obese patients develop multiple organ failure (MOF) at a greater rate than do normal weight counterparts. Evaluation of differences in resuscitative practices altered by body mass index (BMI) might provide an explanation for the increased risk of MOF seen in these high-risk patients.
METHODS: We used prospectively collected multicenter data to retrospectively compare patients grouped by BMI with regard to resuscitation volumes and traditional end points during the first 48 hours after injury. Marshall MOF score was used as the primary outcome measure.
RESULTS: One thousand sixty-six patients were analyzed, with 877 meeting inclusion and exclusion criteria. All patients received similar volumes of resuscitation per kilogram lean and ideal body weight. Morbidly obese patients attained greater central venous pressures but otherwise differed little in attainment of standard cardiovascular end points. Despite this, morbidly obese patients resolved base deficit more slowly and remained in metabolic acidosis for 48 hours postinjury. Morbidly obese patients with persistent metabolic acidosis developed MOF at a significantly greater rate than did normal weight patients with or without persistent metabolic acidosis.
CONCLUSIONS: Morbidly obese trauma patients show prolonged metabolic acidosis despite receiving similar volumes and attaining similar end points of resuscitation when compared with patients in other BMI groups. Inadequate resuscitation based on inaccurate end points and metabolic disturbances associated with increased BMI are likely responsible; identification of the etiology, sources, and consequences of this acidosis may provide further insight into the susceptibility of the morbidly obese patient to develop postinjury organ failure.
Authors:
Robert D Winfield; Matthew J Delano; Lawrence Lottenberg; Juan C Cendan; Lyle L Moldawer; Ronald V Maier; Joseph Cuschieri
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Journal of trauma     Volume:  68     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-15     Completed Date:  2010-04-01     Revised Date:  2014-05-23    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  317-30     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Acidosis / epidemiology*,  physiopathology,  therapy
Adult
Body Mass Index
Female
Fluid Therapy*
Humans
Male
Middle Aged
Multiple Organ Failure / epidemiology*
Obesity, Morbid / epidemiology*,  metabolism*,  physiopathology,  therapy
Resuscitation
Retrospective Studies
Risk Factors
Wounds, Nonpenetrating / epidemiology*,  physiopathology
Grant Support
ID/Acronym/Agency:
R01 GM040586/GM/NIGMS NIH HHS; T32 CA106493/CA/NCI NIH HHS; T32 CA106493-02/CA/NCI NIH HHS; T32 GM-08421/GM/NIGMS NIH HHS; T32 GM008721/GM/NIGMS NIH HHS; U54 GM062119/GM/NIGMS NIH HHS; U54 GM062119-1/GM/NIGMS NIH HHS
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