Standardized trauma resuscitation: Female hearts respond better

McKinley, Kozar, Christine S Cocanour, Sailors, Ware, Moore, Valdivia

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Hypothesis: Women respond better to standardized shock resuscitation compared with similarly severely injured men. Design: Severely injured patients who met specific criteria were resuscitated using a standardized protocol with no adjustment for gender. The resuscitation protocol was used to attain and to maintain an oxygen delivery index of 600 mL/min·m2 or greater (DO 2I≥600) for the first 24 hours in the intensive care unit (ICU). Interventions, responses, and outcomes for the 2 cohorts were compared. Data were analyzed using analysis of variance, X 2, and t tests; P<.05 was considered significant. Setting: A 20-bed regional level I trauma center ICU. Patients: Patients at high risk of postinjury multiple organ failure (major organ or vascular injury and/or skeletal fractures, initial arterial base deficit of 6 mEq/L or greater, requirement for 6 units or more of packed red blood cells in the first 12 hours after hospital admission, or age ≥65 years with any 2 previous criteria). Interventions: Pulmonary artery catheter, packed red blood cell transfusion, crystalloid fluid infusion, inotrope, and vasopressor support, as needed, in that sequence, to maintain DO 2I≥600. Main Outcome Measures: Hemodynamic response to resuscitation, fluid, and packed red blood cell volume. Results: During 2000, 58 patients (38 men, 20 women) met criteria and were resuscitated using our standardized protocol. Demographics and outcomes were similar for both cohorts. Requirements for and responses to standardized resuscitation were also similar, except for volume loading. The female cohort required less lactated Ringer solution volume (12± 1 vs 8±2 L, P<.05), required less Starling curve intervention (42% vs 15%, P<.05), and maintained the DO 2I goal with average pulmonary capillary wedge pressure that was less than that of the male cohort. Conclusion: Review of prospective data from standardized shock resuscitation for female and male cohorts demonstrates that women respond better to standardized resuscitation compared with similarly severely injured men.

Original languageEnglish (US)
Pages (from-to)578-584
Number of pages7
JournalArchives of Surgery
Volume137
Issue number5
StatePublished - 2002
Externally publishedYes

Fingerprint

Resuscitation
Wounds and Injuries
Intensive Care Units
Shock
Erythrocytes
Starlings
Erythrocyte Transfusion
Pulmonary Wedge Pressure
Multiple Organ Failure
Trauma Centers
Vascular System Injuries
Blood Volume
Hematocrit
Pulmonary Artery
Analysis of Variance
Catheters
Hemodynamics
Demography
Outcome Assessment (Health Care)
Oxygen

ASJC Scopus subject areas

  • Surgery

Cite this

McKinley, Kozar, Cocanour, C. S., Sailors, Ware, Moore, & Valdivia (2002). Standardized trauma resuscitation: Female hearts respond better. Archives of Surgery, 137(5), 578-584.

Standardized trauma resuscitation : Female hearts respond better. / McKinley; Kozar, ; Cocanour, Christine S; Sailors; Ware; Moore; Valdivia.

In: Archives of Surgery, Vol. 137, No. 5, 2002, p. 578-584.

Research output: Contribution to journalArticle

McKinley, Kozar, , Cocanour, CS, Sailors, Ware, Moore & Valdivia 2002, 'Standardized trauma resuscitation: Female hearts respond better', Archives of Surgery, vol. 137, no. 5, pp. 578-584.
McKinley, Kozar , Cocanour CS, Sailors, Ware, Moore et al. Standardized trauma resuscitation: Female hearts respond better. Archives of Surgery. 2002;137(5):578-584.
McKinley ; Kozar, ; Cocanour, Christine S ; Sailors ; Ware ; Moore ; Valdivia. / Standardized trauma resuscitation : Female hearts respond better. In: Archives of Surgery. 2002 ; Vol. 137, No. 5. pp. 578-584.
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abstract = "Hypothesis: Women respond better to standardized shock resuscitation compared with similarly severely injured men. Design: Severely injured patients who met specific criteria were resuscitated using a standardized protocol with no adjustment for gender. The resuscitation protocol was used to attain and to maintain an oxygen delivery index of 600 mL/min·m2 or greater (DO 2I≥600) for the first 24 hours in the intensive care unit (ICU). Interventions, responses, and outcomes for the 2 cohorts were compared. Data were analyzed using analysis of variance, X 2, and t tests; P<.05 was considered significant. Setting: A 20-bed regional level I trauma center ICU. Patients: Patients at high risk of postinjury multiple organ failure (major organ or vascular injury and/or skeletal fractures, initial arterial base deficit of 6 mEq/L or greater, requirement for 6 units or more of packed red blood cells in the first 12 hours after hospital admission, or age ≥65 years with any 2 previous criteria). Interventions: Pulmonary artery catheter, packed red blood cell transfusion, crystalloid fluid infusion, inotrope, and vasopressor support, as needed, in that sequence, to maintain DO 2I≥600. Main Outcome Measures: Hemodynamic response to resuscitation, fluid, and packed red blood cell volume. Results: During 2000, 58 patients (38 men, 20 women) met criteria and were resuscitated using our standardized protocol. Demographics and outcomes were similar for both cohorts. Requirements for and responses to standardized resuscitation were also similar, except for volume loading. The female cohort required less lactated Ringer solution volume (12± 1 vs 8±2 L, P<.05), required less Starling curve intervention (42{\%} vs 15{\%}, P<.05), and maintained the DO 2I goal with average pulmonary capillary wedge pressure that was less than that of the male cohort. Conclusion: Review of prospective data from standardized shock resuscitation for female and male cohorts demonstrates that women respond better to standardized resuscitation compared with similarly severely injured men.",
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