DOI: http://dx.doi.org/10.18203/2349-3933.ijam20171012

Early detection with renal Doppler resistive index measurements of hemorrhagic shock in polytrauma patients

Nitishkumar Dhanajirao Yeslawath

Abstract


Background: Poly trauma is a major cause of morbidity and mortality in both developed and developing countries. The aim was to investigate whether renal Doppler RI changes occur early with posttraumatic bleeding and whether the renal Doppler RI may enable accurate prediction of occult hypoperfusion and thus be predictive of the development of hemorrhagic shock in polytrauma patients.

Methods: It was a prospective study involving patients admitted in the causality and evaluated by radiology department. Study was done in a period of 6 months from June 2016-December 2016.  Renal Doppler RI was measured in 48 hemodynamically stable adult patients admitted in emergency because of polytrauma.

Results: 26 patients developed hemorrhagic shock, and 22 did not. Hemorrhagic shock group, as compared with the nonhemorrhagic shock group, had higher renal Doppler RI (mean, 0.79±0.11 [standard deviation] vs 0.61±0.2; P<0.01), injury severity score (mean, 33±12 vs 25±9; P<0.01), and standard base excess (mean, -4.0mEq/L±4 vs 1mEq/L±3; P≤0.05) values. At logistic regression analysis, a renal Doppler RI greater than 0.9 was the only independent risk factor for progression to hemorrhagic shock (P<0.001).

Conclusions: Renal Doppler RI measurement may represent a clinically useful non-invasive method for the early detection of occult hemorrhagic shock.


Keywords


Hemorrhagic shock, Polytrauma, Renal Doppler RI

Full Text:

PDF

References


Matar ZS. The clinical profile of poly trauma and management of abdominal trauma in a general hospital in the central region of the kingdom of Saudi Arabia. Internet J Surg. 2008;14:11.

Kunreuther H. Risk analysis and risk management in an uncertain world. Risk Anal. 2002;22:655-64.

Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health. 2000;90(4):523-6.

Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997;349(9061):1269-76.

Sauaia A, Moore FA, Moore EE. Epidemiology of trauma deaths: a reassessment. J Trauma. 1995;38(2):185-93.

Abramson D, Scalea TM, Hitchcock R, Trooskin SZ, Henry SM, Greenspan J. Lactate clearance and survival following injury. J Trauma. 1993;35(4):584-8.

Gutierrez G, Reines HD, Wulf-Gutierrez ME. Clinical review: hemorrhagic shock. Crit Care. 2004;8(5):373-81.

Yücel N, Lefering R, Maegele M. Trauma associated severe hemorrhage (TASH)-score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma. J Trauma. 2006;60(6):1228-36.

Husain FA, Martin MJ, Mullenix PS, Steele SR, Elliott DC. Serum lactate and base deficit as predictors of mortality and morbidity. Am J Surg. 2003;185(5):485-91.

Lavery RF, Livingston DH, Tortella BJ, Sambol JT, Slomovitz BM, Siegel JH. The utility of venous lactate to triage injured patients in the trauma center. J Am Coll Surg. 2000;190(6):656-64.

Antonelli M, Levy M, Andrews PJD. Hemodynamic monitoring in shock and implications for management: International Consensus Conference, Paris, France, April 27-28, 2006. Intensive Care Med. 2007;33(4):575-90.

Dubin A, Pozo MO, Ferrara G. Systemic and microcirculatory responses to progressive hemorrhage. Intensive Care Med. 2009;35(3):556-64.

Koma LM, Kirberger RM, Scholtz L, Bland-van den Berg P. Influence of normovolemic anemia on Doppler-derived blood velocity ratios of abdominal splanchnic vessels in clinically normal dogs. Vet Radiol Ultrasound. 2005;46(5):427-33.

Stawicki SP, Braslow BM, Panebianco NL. Intensivist use of hand-carried ultrasonography to measure IVC collapsibility in estimating intravascular volume status: correlations with CVP. J Am Coll Surg. 2009;209(1):55-61.

Sefidbakht S, Assadsangabi R, Abbasi HR, Nabavizadeh A. Sonographic measurement of the inferior vena cava as a predictor of shock in trauma patients. Emerg Radiol. 2007;14(3):181-5.

Wo CC, Shoemaker WC, Appel PL, Bishop MH, Kram HB, Hardin E. Unreliability of blood pressure and heart rate to evaluate cardiac output in emergency resuscitation and critical illness. Crit Care Med. 1993;21(2):218-23.