Value of Urine Osmolality as a Monitoring Tool in Comparison with Central Venous Pressure in Resuscitation of Traumatic Hypovolemic Patients

Abstract

Introduction: Hypovolemia is by far the commonest cause of shock and death in traumatic patients, results in multiple organ failure due to inadequate circulating volume and subsequent inadequate oxygen perfusion to organs and tissues. Fluid disturbance and resuscitation can be assessed and monitored by clinical observation by invasive or non-invasive method. One of the non-invasive methods is the urine osmolality an easy, and non-complicated method. Objective: Enhance the management of traumatic hypovolemic shock in emergency department through rapid evaluation of quantity and quality of hydration by a single physiological non-invasive method: the urine osmolality. Methods: This diagnostic cross-sectional comparative study was conducted in emergency department and randomly 40 patients with hypovolemic shock after severe major trauma during the preceding 8 hours according to the inclusion and exclusion criteria. Assessment is done according to primary survey for multiple trauma patient (ABCDE) approach. Results: The urine osmolality was significantly decreased during follow-up, from 1009±103.2 mOsm/kg H2O at admission to 759.8±69.1 mOsm/kg H2O at 8 hours (p<0.0001), with about -25% change percent. The CVP was significantly increased during follow-up, from 5.0±1.9 cmH2O at admission to 8.7±2.6 cmH2O at 8 hours (p<0.0001), with 74% change percent. There was significant intermediate correlation between urine osmolality and CVP of the studied population (r=0.36, p=0.025). Conclusion: Urine osmolality had good diagnostic values (86.0%) in comparison to CVP in monitoring resuscitation of traumatic hypovolemic patients.