Document Detail


A physicochemical approach to acid-base balance in critically ill trauma patients minimizes errors and reduces inappropriate plasma volume expansion.
MedLine Citation:
PMID:  19359913     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: This study assesses if a physicochemical (PC) approach to acid-base balance improves the accuracy of acid-base diagnosis, and reduces inappropriate fluid loading. METHODS: Hundred consecutive patients with trauma admitted to a surgical intensive care unit at a level I trauma center were prospectively analyzed. Demographics, acid-base data and diagnoses, and interventions were collected. Patients were cared for by one physician using a PC approach, or four using conventional (CONV) acid-base balance techniques. The diagnoses and interventions made by CONV physicians were reviewed by the PC physician for accuracy and appropriateness using PC techniques. Data are mean +/- SD or percents; p values reflect PC evaluation of CONV analysis. RESULTS: There were 50 PC patients and 50 CONV. There were no differences in age (p = 0.13), injury severity score (p = 0.21), number of operations (p = 0.87), transfusions (p = 0.87), or survival (p = 0.15). CONV missed 12 diagnoses of metabolic acidosis (p = 0.03), 10 of hyperchloremic metabolic acidosis (p = 0.003), 11 metabolic alkalosis (p = 0.02), and 19 tertiary disorders (p < 0.001). CONV missed 38 diagnoses of increased unmeasured ions (p < 0.001). PC normalized their acid-base balance sooner than CONV (3.3 days +/- 3.4 days vs. 8.3 days +/- 7.4 days, p < 0.01). CONCLUSIONS: A PC approach improves acid-base diagnosis accuracy. CONV often miss acidosis (particularly those because of hyperchloremia), alkalosis, and tertiary disorders. Inappropriate volume loading follows in the wake of misinterpretation of increased base deficit using CONV and is avoided using PC. PC-directed therapy normalizes acid-base balance more rapidly than CONV.
Authors:
Lewis J Kaplan; Nora Ham-Ting Cheung; Linda Maerz; Felix Lui; Kevin Schuster; Gina Luckianow; Kimberly Davis
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  66     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-10     Completed Date:  2009-05-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1045-51     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Section of Trauma, Surgical Critical Care and Surgical Emergencies, Yale University School of Medicine, New Haven, Connecticut 06518, USA. lewis.kaplan@yale.edu
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MeSH Terms
Descriptor/Qualifier:
Accidents, Traffic
Acid-Base Imbalance / diagnosis*
Adult
Anions / blood
Blood Gas Analysis
Critical Illness
Decision Trees
Fluid Therapy*
Humans
Intensive Care Units
Middle Aged
Physicochemical Phenomena
Plasma Volume
Wounds and Injuries / physiopathology,  therapy
Wounds, Gunshot
Chemical
Reg. No./Substance:
0/Anions

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