Monitoring and End-Points of Trauma Resuscitation

Abstract

Monitoring end-points of trauma resuscitation and understanding principles of hemostatic resuscitation have become important in the management of severely injured patients. The purpose of this review is to discuss a selected number of parameters used to guide resuscitation of trauma patients. In trauma, shock occurs because of inadequate tissue perfusion and oxygen delivery. The goal of resuscitation is to restore adequate tissue perfusion while avoiding over-resuscitation and associated complications. Understanding of the dynamic cardiopulmonary interactions provides the physician with a tool to evaluate pulse pressure variation and stroke volume variation. Measurements of mixed and central venous oxygen saturation give an indication of systemic oxygen extraction. Bedside echocardiography has dramatically improved the diagnostic evaluation of patients in shock. The metabolic markers of perfusion are indicators of micro-circulation resuscitation and include characterization of oxygen extraction, lactate production, and base deficit. Characterization of regional oxygen delivery is an evolving field with new technological developments. Despite the numerous measures used to characterize end-points of trauma resuscitation, there is no clear single measure used to guide optimal resuscitation. The physician must provide careful interrogation of hemodynamic, metabolic, and hemostatic parameters and their respective trends over time to establish optimal therapy. The use of thromboelastography to guide hemostatic resuscitation has the potential to optimize individual patient resuscitation thereby reducing unnecessary blood product utilization. Careful monitoring of end-points of trauma resuscitation and understanding of hemostatic resuscitation are needed to guide resuscitation of critically ill patients and improve outcomes.