Normal versus supranormal oxygen delivery goals in shock resuscitation: The response is the same

Bruce A. McKinley, Rosemary A. Kozar, Christine S Cocanour, Alicia Valdivia, R. Matthew Sailors, Drue N. Ware, Frederick A. Moore

Research output: Contribution to journalArticlepeer-review

76 Scopus citations

Abstract

Background: Shock resuscitation is integral to early management of severely injured patients. Our standardized shock resuscitation protocol, developed in 1997 and implemented as a computerized intensive care unit (ICU) bedside decision support tool in 2000, used oxygen delivery index (Do2I) ≥ 600 mL/min/m2 as the intervention endpoint. In a recent publication, Shoemaker et al. refuted positive outcome effect of early supranormal Do2 (i.e., Do2I ≥ 600) resuscitation. In response to and because of ongoing concern for excessive volume loading, we decreased our Do2I endpoint from 600 to 500. Our hypothesis was that by decreasing the Do2I endpoint, less crystalloid would be administered. We compare resuscitation responses to the protocol with goals of Do2I ≥ 600 versus 500 in two patient cohorts. Methods: A standardized protocol was used to direct bedside decisions for resuscitation of patients with major injury (Injury Severity Score > 15), blood loss (≥ 6 units of packed red blood cells), metabolic stress (base deficit ≥ 6 mEq/L), and no severe brain injury. The protocol logic is to attain and maintain Do2I ≥ a specified goal for the first 24 ICU hours using primarily blood and volume loading. Two cohorts were compared: Do2I ≥ 500 (18 patients admitted February-August 2001) versus Do2I ≥ 600 (18 patients admitted during 2000 age and gender matched with the Do2I ≥ 500 group). Data were analyzed using analysis of variance, X2, and t tests (p < 0.05). Results: Both groups had similar demographics (age 30 ± 3 years; 78% men; Injury Severity Score 27 ± 3), hemodynamics, and severity of shock at start of resuscitation in the ICU. Resuscitation response was Do2I increase to ≥ 600 for both cohorts within ∼12 hours. Throughout the 24-hour ICU process, the Do2I ≥ 500 cohort received less lactated Ringer's volume than the Do2I ≥ 600 cohort (total of 8 ± 1 vs. 12 ± 2 L; p < 0.05) and tended to receive less blood transfusion (total of 3 ± 1 vs. 5 ± 1 units of packed red blood cells). Conclusion: Shock resuscitation using Do2I ≥ 500 was indistinguishable from Do2I ≥ 600 mL/min/m2. Less volume loading was required to attain and maintain Do2I ≥ 500 than 600 using computerized protocol technology to standardize resuscitation during the first 24 ICU hours.

Original languageEnglish (US)
Pages (from-to)825-832
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume53
Issue number5
StatePublished - Nov 1 2002
Externally publishedYes

Keywords

  • Hemodynamics
  • Oxygen delivery index
  • Resuscitation
  • Shock
  • Supranormal performance
  • Trauma hemorrhage

ASJC Scopus subject areas

  • Surgery

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