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Abstract

Introduction: Few studies assess the effectiveness of early goal directed resuscitation (EGDR) between traumatic and septic shock patients during the first 72 hours. The purpose of this observational study was to compare the responsiveness to EGDR between these two groups. Methods: An EGDR algorithm was developed and included: insertion of an Edwards ScvO2 catheter within 1 hour of ICU admission, CVP >8, ScvO2≥70%, MAP ≥65. Patients at high risk of poor outcome included those with SBP<90 after initial bolus of fluid, lactate ≥ 2.5, base deficit ≥ 6, multi-trauma and elderly trauma patients requiring ICU care, massive transfusion protocol activation, or septic/trauma patients with severe comorbidities. The lactate, MAP, HCT, arterial pH, P/F ratio, ScvO2, CO, creatinine, amount of crystalloid, ffp, platelets, prbc received, and vasopressor /inotrope requirements were recorded at 6, 12, 24, and 72 hours. The resting energy expenditure (REE) was calculated at initial and 24-hr of resuscitation by the Fick equation. Results: Fifty five patients met criteria (trauma N=37, sepsis N=18). Septic patients were found to have higher comorbidities and required significantly more crystalloid at the 6, 24, and 72-hour time points and more pressor requirements at 24 and 72 hours. The trauma group had significantly lower P/F ratio at all time points. There were no significant differences in CVP, MAP, ScvO2, or CO, transfusion requirements, lactate, or base deficit between the groups. The REE was lower than expected in both groups (trauma avg. initial:1629 kcal, 24-hour: 1221 kcal; Septic avg.initial 1224 kcal; 24-hour: 1662 kcal) but without significant differences. There was 1 death within 72 hours (trauma group) Conclusions: When applying EGDR, patients with septic shock will require more crystalloids and vasopressor medication to meet the endpoints of resuscitation. Lactic acid and base deficit are cleared in both groups despite low REE through unclear mechanisms. A larger study is needed to further compare the physiological effects of EGDR between these groups