Triage vital signs do not correlate with serum lactate or base deficit, and are less predictive of operative intervention in penetrating trauma patients: a prospective cohort study.

BACKGROUND: Triage vital signs are often used to help determine a trauma patient's haemodynamic status. Recent studies have demonstrated that these may not be very specific in determining major injury. The purpose of this study was to determine if there is any correlation between triage vital signs, base deficit (BD) and lactate, and to determine the odds of operative intervention in penetrating trauma patients. METHODS: A prospective observational cohort study was undertaken. Baseline vital signs, BD and lactate were recorded in all patients for whom the trauma team was activated. Pearson correlation and coefficient (ρ) were calculated. ORs were calculated. RESULTS: 75 patients were enrolled. Pearson correlations and coefficients calculated for lactate to systolic blood pressure were: -0.052 (ρ=0.0011, 95% CI -0.225 to 0.228); lactate and HR: 0.23 (ρ=0.0166, 95% CI -0.211 to 0.242); lactate and RR: 0.23 (ρ=0.054, 95% CI -0.174 to 0.277). BD to systolic blood pressure were: 0.003 (ρ=0.00001, 95% CI -0.229 to 0.224); BD and HR: -0.19 (ρ=0.038, 95% CI -0.399 to 0.038); BD and RR: -0.019 (ρ=0.0004, 95% CI -0.244 to 0.208). Odds of operative intervention were greater in patients with abnormally high lactate, OR 4.17 (95% CI 1.57 to 11), but not for BD, OR 2.53 (95% CI 0.99 to 6.45), or any of the vital signs. CONCLUSIONS: Triage vital signs have no correlation to lactate or BD levels in penetrating trauma patients. Odds of operative intervention are greater in patients with abnormally high serum lactate levels, but not in those with abnormal triage vital signs or BD.

Emergency Department use of Apneic Oxygenation Versus Usual Care During Rapid Sequence Intubation: A Randomized Controlled Trial (The ENDAO Trial).

OBJECTIVES: Desaturation leading to hypoxemia may occur during rapid sequence intubation (RSI). Apneic oxygenation (AO) was developed to prevent the occurrence of oxygen desaturation during the apnea period. The purpose of this study was to determine if the application of AO increases the average lowest oxygen saturation during RSI when compared to usual care (UC) in the emergency setting. METHODS: A randomized controlled trial was conducted at an academic, urban, Level I trauma center. All patients requiring intubation were included. Exclusion criteria were patients in cardiac or traumatic arrest or if preoxygenation was not performed. An observer, blinded to study outcomes and who was not involved in the procedure, recorded all times, while all saturations were recorded in real time by monitors on a secured server. Two-hundred patients were allocated to receive AO (n = 100) or UC (n = 100) by predetermined randomization in a 1:1 ratio. RESULTS: A total of 206 patients were enrolled. There was no difference in lowest mean oxygen saturation between the two groups (92, 95% confidence interval [CI] = 91 to 93 in AO vs. 93, 95% CI = 92 to 94 in UC; p = 0.11). CONCLUSION: There was no difference in lowest mean oxygen saturation between the two groups. The application of AO during RSI did not prevent desaturation of patients in this study population.

Nasal cannula end-tidal CO2 correlates with serum lactate levels and odds of operative intervention in penetrating trauma patients: a prospective cohort study.

BACKGROUND: Penetrating trauma patients in shock often require urgent operative intervention. Studies have demonstrated that variables obtained in the emergency department, such as lactate levels, can help the physician determine the presence of hemorrhagic shock, leading to more rapid intervention and improve prognosis in trauma patients. The purpose of the study is to determine if end-tidal (ET) CO2 correlates with serum lactate levels, a measure of tissue hypoxia and subsequently shock, in penetrating trauma patients. Secondarily, we sought to determine whether ET CO2 could be used to determine the patient's odds of requiring operative intervention. METHODS: A prospective observational cohort study was undertaken at an urban Level 1 trauma center. Baseline ET CO2 from nasal cannula and serum lactate level were recorded in all patients in whom the trauma team was activated. Outcomes defined were whether operative intervention was needed. Pearson correlation (R), correlation coefficient (r(2)), and odds ratio were calculated. RESULTS: One hundred five patients were enrolled. Pearson correlations and coefficients calculated for serum lactate level to ET CO2 were R = -0.86 (r(2) = 0.74, p < 0.0001). Of patients requiring operative intervention, 81.97% had abnormally low ET CO2 and 54.1% had abnormally high serum lactate levels. Odds ratios of patients needing an emergent operation with abnormally low ET CO2 was 20.4 (95% confidence interval, 7.47-55.96) and with abnormally high serum lactate levels was 4 (95% confidence interval, 1.68-5.93). CONCLUSION: ET CO2 has a strong inverse correlation to serum lactate levels. Abnormally low ET CO2 values were associated with greater increased odds compared with serum lactate levels of penetrating trauma patients requiring operative intervention. LEVEL OF EVIDENCE: Prognostic/diagnostic study, level I.