MIS-TRIAGE TO CENTRAL VENOUS PRESSURE (CVP) DIRECTED RESUSCITATION (RESUS) IS ASSOCIATED WITH POOR OUTCOME

Abstract

In response to pulmonary artery catheter (PAC) controversy, we developed a CVP directed resus protocol as alternative to our PAC protocol. Both were implemented using computerized decision support. If CVP resus proved inadequate, PAC resus was started. We hypothesized appropriate protocol assignment by trauma surgeon (TS) assessment of stability at intensive care unit (ICU) admit. Data from 106 consecutive patients meeting criteria over 12 mo ending 07/31/2005 are summarized below.TablePAC patients had more severe injury and shock, required more resus, had longer ICU stay and poorer survival than CVP. Seven patients progressed from CVP to PAC directed resus. This subgroup had injury severity, shock and preICU/ICU resus similar to PAC, but poorest survival (57%.) TSs chose CVP directed resus for >50% of our major torso trauma patients who met criteria, and most did well. Mis-triage to CVP directed resus, however, was associated with poor outcome. These patients may have been appropriately triaged to PAC resus if TS decision focus had been injury severity (ISS), pre ICU transfusion requirement, and magnitude of emergency department base deficit (BD ED.) NIGMS P50GM38529