INDURG TRIAL Protocol: A Randomized Controlled Trial Using Indocyanine Green during Cholecystectomy in Acute Cholecystitis.

INTRODUCTION: Laparoscopic cholecystectomy is one of the most common gastrointestinal surgeries, and bile duct injury is one of its main complications. The use of real-time indocyanine green fluorescence cholangiography allows the identification of extrahepatic biliary structures, facilitating the procedure and reducing the risk of bile duct lesions. A better visualization of the bile duct may help to reduce the need for conversion to open surgery, and may also shorten operating time. The main objective of this study was to determine whether the use of indocyanine green is associated with a reduction in operating time in emergency cholecystectomies. Secondary outcomes are the postoperative hospital stay, the correct intraoperative visualization of the Calot's Triangle structures with the administration of indocyanine green, and the intraoperative complications, postoperative complications and morbidity according to the Clavien-Dindo classification. METHODS: This is a randomized, prospective, controlled, multicenter trial with patients diagnosed with acute cholecystitis requiring emergency cholecystectomy. The control group will comprise 220 patients undergoing emergency laparoscopic cholecystectomy applying the standard technique. The intervention group will comprise 220 patients also undergoing emergency laparoscopic cholecystectomy for acute cholecystitis with prior administration of indocyanine green. CONCLUSION: Due to the lack of published studies on ICG in emergency laparoscopic cholecystectomy, this study may help to establish procedures for its use in the emergency setting.

Analysis of quality of life after major trauma: a spanish follow-up cohort study.

PURPOSE: Study objectives are to determine whether quality of life is recovered completely after major injury and to identify determinants associated with a worse quality of life. METHODS: Prospective 12-month follow-up of injured patients admitted to the intensive care unit in a Spanish level 1 trauma centre. The main outcome (quality of life) was measured using the EQ-5D-5L. The relationships between sociodemographic factors, injury severity and location, and quality of life scores were evaluated. Mean comparison analysis (95% confidence interval) was performed with the student "t" test for quantitative variables and with chi-squared for proportion comparison (qualitative variables). A multivariate logistic regression (odds ratio and 95% confidence interval) was performed to identify determinants of each dimension, and a multivariate linear regression (regression coefficient and 95% confidence interval) to identify the determinants of EQus and EQvas. RESULTS: Over a 2-year period, 304 patients who met the inclusion criteria were identified, and 200 patients (65.8%) were finally included. Most of patients suffered blunt trauma (91.5%), 72.5% were men, mean age was 47.8, mean ISS was 15.2. The overall health index (EQvas) improved slightly, but its mean value at 12 months was below the Spanish population norm (P < 0.001). In the multivariate analysis, age ≥ 55, female gender and unskilled employment were risk factors for a lower EQvas. Also in the multivariate analysis, having a severe extremity injury was associated with a lower score on the mobility dimension (OR 6.56 95% CI 2.00, 21.55) while age ≥ 55 years was associated with a lower score on the usual activities dimension (OR 3.52 95% CI 1.17, 10.57). Female gender was the most important factor associated with suffering pain (OR 4.54, 95% CI 2.01, 10.27) and depression/anxiety (OR 4.04, 95% CI 1.88, 8.65). In the univariate and multivariate analyses, female gender, age ≥ 55 years, ISS ≥ 25 and severe extremity injury were associated with a lower EQ utility score (EQus). CONCLUSIONS: The quality of life score improves during the first year after major trauma. However, it does not return to the reference levels for the normal population. Female gender and age ≥ 55 years are statistically significant determinants of poorer EQvas and EQus.

Aplicación del Shock Index como predictor de hemorragia en el paciente politraumático / The use of the Shock Index as a predictor of active bleeding in trauma patients

INTRODUCCIÓN: Las constantes vitales detectan la presencia de hemorragia al perder grandes cantidades de sangre, lo que comporta una gran morbimortalidad. El Shock Index (SI) es un parámetro que detecta el sangrado con puntos de corte de 0,9. El objetivo de este estudio es valorar si un punto de corte de ≥ 0,8 es más sensible para detectar sangrado oculto, permitiendo iniciar maniobras terapéuticas más precoces. MÉTODOS: Estudio analítico de validación del SI que incluye pacientes politraumatizados graves mayores de 16 años. Se registran constantes vitales y escalas predictivas de sangrado: SI, Assessment of Blood Consumption score y Pulse Rate Over Pressure score. Se analiza la relación del SI con 5 marcadores predictivos de sangrado: necesidad de transfusión masiva, embolización angiográfica, control del sangrado quirúrgico, muerte por shock hipovolémico y "sangrado activo" (presencia de al menos uno de los 4 marcadores anteriores en un paciente). RESULTADOS: Recogida prospectiva de datos de 1.402 pacientes politraumatizados durante 10 años. El Injury Severity Score medio fue de 20,9 (DE 15,8). Hubo una mortalidad del 10%. El SI medio fue de 0,73 (DE 0,29). En total presentaron "sangrado activo" el 18,7% de la serie. El SI medio en los pacientes con "sangrado activo" fue de 0,87, mientras que las constantes vitales estaban dentro de la normalidad. El área bajo la curva ROC del SI para el "sangrado activo" fue de 0,749. CONCLUSIONES: El SI con un punto de corte ≥ 0,8 es más sensible que aquel con el punto de corte ≥ 0,9 y permite iniciar maniobras de reanimación más precoces en los pacientes con sangrado oculto

INTRODUCTION: Vital signs indicate the presence of bleeding only after large amounts of blood have been lost, with high morbidity and mortality. The Shock Index (SI) is a hemorrhage indicator with a cut-off point for the risk of bleeding at 0.9. The aim of this study is to assess whether a cut-off of ≥ 0.8 is more sensitive for detecting occult bleeding, providing for early initiation of therapeutic maneuvers. METHODS: SI analytical validation study of severe trauma patients older than 16 years of age. Vital signs were recorded, and scales for predicting bleeding included: SI, Assessment of Blood Consumption score, and Pulse Rate Over Pressure score. The relationship between the SI and 5 markers for bleeding was analyzed: need for massive transfusion, angiographic embolization, surgical bleeding control, death due to hypovolemic shock, and the overall predictor "active bleeding" (defined as the presence of at least one of the 4 markers above). RESULTS: Data from 1.402 trauma patients were collected prospectively over a period of 10 years. The mean Injury Severity Score was 20.9 (SD 15.8). The mortality rate was 10%. The mean SI was 0.73 (SD 0.29). "Active bleeding" was present in 18.7% of patients. The SI area under the ROC curve for "active bleeding" was 0.749. CONCLUSIONS: An SI cut-off point ≥ 0.8 is more sensitive than ≥ 0.9 and allows for earlier initiation of resuscitation maneuvers in patients with occult active bleeding

The use of the Shock Index as a predictor of active bleeding in trauma patients. / Aplicación del Shock Index como predictor de hemorragia en el paciente politraumático.

INTRODUCTION: Vital signs indicate the presence of bleeding only after large amounts of blood have been lost, with high morbidity and mortality. The Shock Index (SI) is a hemorrhage indicator with a cut-off point for the risk of bleeding at 0.9. The aim of this study is to assess whether a cut-off of≥0.8 is more sensitive for detecting occult bleeding, providing for early initiation of therapeutic maneuvers. METHODS: SI analytical validation study of severe trauma patients older than 16 years of age. Vital signs were recorded, and scales for predicting bleeding included: SI, Assessment of Blood Consumption score, and Pulse Rate Over Pressure score. The relationship between the SI and 5 markers for bleeding was analyzed: need for massive transfusion, angiographic embolization, surgical bleeding control, death due to hypovolemic shock, and the overall predictor «active bleeding¼ (defined as the presence of at least one of the 4 markers above). RESULTS: Data from 1.402 trauma patients were collected prospectively over a period of 10 years. The mean Injury Severity Score was 20.9 (SD 15.8). The mortality rate was 10%. The mean SI was 0.73 (SD 0.29). «Active bleeding¼ was present in 18.7% of patients. The SI area under the ROC curve for «active bleeding¼ was 0.749. CONCLUSIONS: An SI cut-off point≥0.8 is more sensitive than≥0.9 and allows for earlier initiation of resuscitation maneuvers in patients with occult active bleeding.

Resultados del tratamiento conservador en pacientes con neumotórax oculto / Results of conservative treatment in patients with occult pneumothorax

INTRODUCCIÓN: Alrededor del 2-15% de los pacientes politraumatizados presentan un neumotórax oculto. La aplicación del tratamiento conservador (observación) en la práctica clínica diaria aún sigue siendo controvertido. Nuestra hipótesis es que es factible realizar un tratamiento conservador. El objetivo de este estudio es evaluar la eficacia y los efectos adversos del tratamiento conservador del neumotórax oculto en nuestro medio. MÉTODOS: Estudio observacional retrospectivo (análisis de base de datos con registro prospectivo) realizado en un hospital universitario de nivel II. Inclusión de 1.087 pacientes politraumatizados mayores de 16 años ingresados en el área de críticos desde 2006 hasta 2013. RESULTADOS: En este periodo, 126 pacientes presentaron neumotórax oculto, en 73 (58%) se decidió observación. En 9 pacientes (12%) fracasó la observación (precisaron colocación de drenaje pleural) por aumento del neumotórax o aparición de hemotórax. De los pacientes observados, 16 fueron ventilados bajo presión positiva. En este grupo fracasó la observación en 3 pacientes (19%). Ningún paciente presentó neumotórax a tensión u otro problema relacionado con la ausencia de drenaje. No hubo diferencias entre grupos (observación vs. drenaje) respecto a mortalidad, estancia hospitalaria ni estancia en la unidad de críticos. CONCLUSIÓN: El tratamiento de elección de los pacientes con neumotórax oculto es la observación clínica. Este tratamiento también es factible en los pacientes ventilados bajo presión positiva

INTRODUCTION: An occult pneumothorax is found in 2-15% trauma patients. Observation (without tube thoracostomy) in these patients presents still some controversies in the clinical practice. The objective of the study is to evaluate the efficacy and the adverse effects when observation is performed. METHODS: A retrospective observational study was undertaken in our center (university hospital level II). Data was obtained from a database with prospective registration. A total of 1087 trauma patients admitted in the intensive care unit from 2006 to 2013 were included. RESULTS: In this period, 126 patients with occult pneumothorax were identified, 73 patients (58%) underwent immediate tube thoracostomy and 53 patients (42%) were observed. Nine patients (12%) failed observation and required tube thoracostomy for pneumothorax progression or hemothorax. No patient developed a tension pneumothorax or experienced another adverse event related to the absence of tube thoracostomy. Of the observed patients 16 were under positive pressure ventilation, in this group 3 patients (19%) failed observation. There were no differences in mortality, hospital length of stay or intensive care length of stay between the observed and non-observed group. CONCLUSION: Observation is a safe treatment in occult pneumothorax, even in pressure positive ventilated patients

Registro prospectivo en politraumatismos graves. Análisis de 1.200 pacientes / Prospective registry of severe polytrauma. Analysis of 1200 patients

INTRODUCCIÓN: El politraumatismo sigue siendo una de las principales causas de muerte entre los 10 y los 40 años, causando graves incapacidades en los pacientes que sobreviven. El objetivo de nuestro estudio es realizar un análisis de calidad de la atención del paciente politraumatizado mediante un estudio epidemiológico. MÉTODO: Registro prospectivo de todos los pacientes politraumáticos atendidos en nuestro hospital, mayores de 16 años, que ingresan en el área de críticos o mueren antes del ingreso. RESULTADOS: Desde marzo del 2006 hasta agosto del 2014, registramos 1.200 politraumatizados. La mayoría fueron hombres (75%), con una mediana de edad de 45 años. El ISS medio fue de 20,9 ± 15,8 y el mecanismo de acción más frecuente fue cerrado (94% casos). La mortalidad global fue del 9,8% (117 casos), siendo la muerte neurológica la principal causa de fallecimiento (45,3%), seguida de la muerte por shock hipovolémico (29,1%). En 17 casos (14,5% fallecimiento) la mortalidad fue considerada como evitable o potencialmente evitable un total de 327 pacientes (27,3%) precisaron de tratamiento quirúrgico urgente y 106 pacientes (8,8%) precisaron de un tratamiento mediante radiología intervencionista de carácter urgente. El 18,5% de los pacientes (222) presentaron alguna lesión inadvertida, con un total de 318 lesiones inadvertidas. CONCLUSIÓN: La atención ofrecida en nuestro centro es correcta. La necesidad de una recogida de datos prospectiva de la atención global a los pacientes politraumatizados es necesaria e imprescindible para poder evaluar la calidad ofrecida y mejorar los resultados

INTRODUCTION: Polytrauma continues to be one of the main causes of death in the population between 10-40 years of age, and causes severe discapability in surviving patients. The aim of this study is to perform an analysis of the quality of care of the polytrauma patient using an epidemiological study. METHOD: Prospective registry of all polytrauma patients treated at our hospital over 16 years of age, admitted to the critical care area or dead before admission. RESULTS: From March 2006 to August 2014, we registered 1200 polytrauma patients. The majority were men (75%) with a median age of 45. The mean ISS was 20,9 ± 15,8 and the most common mechanism of injury was blunt trauma (94% cases), The global mortality rate was 9.8% (117 cases), and neurological death was the most frequent cause (45.3%), followed by hypovolemic shock (29,1%). In 17 cases (14,5% of deaths) mortality was considered evitable or potentially evitable, A total of 327 patients (27.3%) needed emergency surgery and 106 patients (8,8%) needed emergency treatment using interventional radiology. 18,5% of patients (222) presented an inadverted injury, with a total of 318 inadverted injuries. CONCLUSION: Trauma care at our centre is adequate. A prospective registry of the global care of polytrauma patients is necessary to evaluate the quality of care and improve results

Prospective registry of severe polytrauma. Analysis of 1200 patients.

INTRODUCTION: Polytrauma continues to be one of the main causes of death in the population between 10-40 years of age, and causes severe discapability in surviving patients. The aim of this study is to perform an analysis of the quality of care of the polytrauma patient using an epidemiological study. METHOD: Prospective registry of all polytrauma patients treated at our hospital over 16 years of age, admitted to the critical care area or dead before admission. RESULTS: From March 2006 to August 2014, we registered 1200 polytrauma patients. The majority were men (75%) with a median age of 45. The mean ISS was 20,9±15,8 and the most common mechanism of injury was blunt trauma (94% cases), The global mortality rate was 9.8% (117 cases), and neurological death was the most frequent cause (45.3%), followed by hypovolemic shock (29,1%). In 17 cases (14,5% of deaths) mortality was considered evitable or potentially evitable, A total of 327 patients (27.3%) needed emergency surgery and 106 patients (8,8%) needed emergency treatment using interventional radiology. 18,5% of patients (222) presented an inadverted injury, with a total of 318 inadverted injuries. CONCLUSION: Trauma care at our centre is adequate. A prospective registry of the global care of polytrauma patients is necessary to evaluate the quality of care and improve results.

[Results of conservative treatment in patients with occult pneumothorax]. / Resultados del tratamiento conservador en pacientes con neumotórax oculto.

INTRODUCTION: An occult pneumothorax is found in 2-15% trauma patients. Observation (without tube thoracostomy) in these patients presents still some controversies in the clinical practice. The objective of the study is to evaluate the efficacy and the adverse effects when observation is performed. METHODS: A retrospective observational study was undertaken in our center (university hospital level II). Data was obtained from a database with prospective registration. A total of 1087 trauma patients admitted in the intensive care unit from 2006 to 2013 were included. RESULTS: In this period, 126 patients with occult pneumothorax were identified, 73 patients (58%) underwent immediate tube thoracostomy and 53 patients (42%) were observed. Nine patients (12%) failed observation and required tube thoracostomy for pneumothorax progression or hemothorax. No patient developed a tension pneumothorax or experienced another adverse event related to the absence of tube thoracostomy. Of the observed patients 16 were under positive pressure ventilation, in this group 3 patients (19%) failed observation. There were no differences in mortality, hospital length of stay or intensive care length of stay between the observed and non-observed group. CONCLUSION: Observation is a safe treatment in occult pneumothorax, even in pressure positive ventilated patients.

Pileflebitis y abscesos hepáticos secundarios a apendicitis aguda evolucionada / Pylephlebitis and liver abscesses secondary to acute advanced appendicitis

No disponible

El uso de Gastrografin ® en el manejo del cuadro de oclusión intestinal adherencial / Use of Gastrografin ® in the management of adhesion intestinal obstruction

Introducción Las adherencias son la causa más importante de oclusión intestinal, suponen un 25% de las consultas por dolor abdominal. Con un correcto manejo de este cuadro, la mortalidad asociada puede ser menor de un 5-10%. El Gastrografin® puede ayudar a ello. Objetivo La aplicación de un protocolo de manejo de la oclusión intestinal adherencial con Gastrografin® es segura y permite disminuir la estancia hospitalaria y el tiempo de indicación de cirugía por fallo del tratamiento conservador. Material y método Estudio prospectivo observacional, siguiendo un protocolo preestablecido. Una vez diagnosticado el cuadro, descartadas otras causas de oclusión y la presencia de sufrimiento intestinal, se administra Gastrografin® y se inicia tratamiento conservador. Si el Gastrografin® pasa al colon en el control de las 8, 12 o 24 h posteriores a su administración, se considera la oclusión como parcial, se inicia dieta oral y se evalúa el alta. Si no pasa el contraste a las 24 h, se indica cirugía .Resultados Desde enero de 2009 hasta diciembre de 2011, se trataron 211 episodios (164 pacientes). En 170 episodios se administró contraste con llegada del mismo al colon en 142 episodios (104 episodios a las 8 h, 11 a las 12 h y 27 a las 24 h) Se intervienen a 28 pacientes por fallo del tratamiento conservador y a 5 por otras causas. Conclusiones La aplicación de un protocolo en el que se incluye el uso de Gastrografin® en la oclusión intestinal adherencial es seguro y permite tomar decisiones terapéuticas con mayor celeridad y con una menor estancia hospitalaria (AU)

Background Adhesions are the most important cause of intestinal obstruction. Approximately 25% of surgical admissions for acute abdominal conditions are due to intestinal obstruction. Better diagnostic and treatment methods of intestinal obstruction could potentially reduce mortality rate to 5-10%. Gastrografin® could contribute to this achieve this. Aim To present a protocol to treat adhesion intestinal obstruction with Gastrografin® that is safe, and allows shorter hospital stays and shorter time between admission and surgery. Material and methods All patients with adhesion intestinal obstruction without symptoms of strangulation were treated with Gastrografin®, intravenous fluids and nasogastric tube. Those in whom contrast reach the colon in 8, 12 or 24 hours were considered to have partial obstruction, and were fed orally. If Gastrografin® failed in the following 24 hours, a laparotomy was performed. Results Out of a total of 211 episodes (164 patients), 170 episodes received contrast and in 142 cases Gastrografin® reached the colon (104 episodes at 8 h, 11 at 12 h, and 27 at 24 h). A laparotomy was required in 28 patients because of failed treatment, and in another 5 for other causes. Conclusions A management protocol for adhesion intestinal obstruction with Gastrografin® is safe, reduces morbidity and mortality, and leads to a shorter hospital stay (AU)

[Use of Gastrografin(®) in the management of adhesion intestinal obstruction]. / El uso de Gastrografin(®) en el manejo del cuadro de oclusión intestinal adherencial.

BACKGROUND: Adhesions are the most important cause of intestinal obstruction. Approximately 25% of surgical admissions for acute abdominal conditions are due to intestinal obstruction. Better diagnostic and treatment methods of intestinal obstruction could potentially reduce mortality rate to 5-10%. Gastrografin(®) could contribute to this achieve this. AIM: To present a protocol to treat adhesion intestinal obstruction with Gastrografin(®) that is safe, and allows shorter hospital stays and shorter time between admission and surgery. MATERIAL AND METHODS: All patients with adhesion intestinal obstruction without symptoms of strangulation were treated with Gastrografin(®), intravenous fluids and nasogastric tube. Those in whom contrast reach the colon in 8, 12 or 24hours were considered to have partial obstruction, and were fed orally. If Gastrografin(®) failed in the following 24hours, a laparotomy was performed. RESULTS: Out of a total of 211 episodes (164 patients), 170 episodes received contrast and in 142 cases Gastrografin(®) reached the colon (104 episodes at 8h, 11 at 12h, and 27 at 24h). A laparotomy was required in 28 patients because of failed treatment, and in another 5 for other causes. CONCLUSIONS: A management protocol for adhesion intestinal obstruction with Gastrografin(®) is safe, reduces morbidity and mortality, and leads to a shorter hospital stay.

Medición del ácido láctico en pacientes politraumatizados y su utilidad como factor predictor de mortalidad y fallo multiorgánico / Measurement of lactic acid in multiple injury patients and its usefulness as a predictor of multiorgan failure and mortality

Introducción La utilización del ácido láctico como marcador de hipoperfusión oculta y su relación con el fracaso multiorgánico (FMO) y/o la mortalidad están sujetas a debate. Material y método Estudio prospectivo incluyendo pacientes politraumatizados mayores de 16a ingresados en el área de críticos. Se registra el ácido láctico inicial y a las 24h del traumatismo relacionándolo con la morbimortalidad de los pacientes. Resultados Se incluyen en el estudio 342 pacientes con un injury severity score medio de 24,1. Los pacientes que sobreviven tienen un ácido láctico inicial y a las 24h del traumatismo de 27,8 y 17,9 (valores normales inferiores a 22mg/dl), elevándose a 36,5 y 40,2 en los que mueren. No existen diferencias entre el ácido láctico inicial en los pacientes con y sin FMO, elevándose a las 24h en los que presentan FMO (17,8 vs 26,7).Los pacientes con un ácido láctico que empeora o se mantiene patológico en 24h tienen mayor mortalidad que cuando se mantiene bien o mejora (25%-17,1% vs 6,3%-0,8%), aumentando también el porcentaje de pacientes con FMO (40,6%-32,8% vs 14,9%-11,1%).En pacientes hemodinámicamente estables, también existe mayor mortalidad cuando el ácido láctico empeora o se mantiene patológico en las primeras 24h (23,8%-19,2% vs 8,8%-0%), así como mayor porcentaje de FMO (38,1%-26,9% vs 10,9%-7,6%).Conclusiones La evolución del ácido láctico en las primeras 24h del politraumatismo tiene relación con la mortalidad y el FMO, incluso cuando el paciente está hemodinámicamente estable (AU)

Introduction The use of lactic acid as marker of occult hyperfusion and its relationship with multiorgan failure (MOF) and/or mortality is a subject of debate. Material and method A prospective study was conducted on multiple injury patients over 16 years of age in critical care areas. The lactic acid was measured at the beginning and at 24hours of the trauma and associating it with the patient morbidity and mortality. Results A total of 342 patients, with a mean injury severity score of 24.1, were included. The patients who survived had an initial, and 24hours after the trauma, lactic acid of 27.8mg/dl and 17.9mg/dl, respectively, (normal values less than 22mg/dl), increasing to 36.5mg/dl and 40.2mg/dl, respectively, in those who died. There were no differences between the initial lactic acid in patients with and without MOF, being increased at 24hours in those who had MOF (17.8 vs 26.7).The patients with a lactic acid that got worse or remained abnormal at 24hours had a higher mortality than those in which it remained the same or improved (25% - 17.1% vs 6.3% - 0.8%), with the percentage of patients with MOF also increasing (40.6% - 32.8% vs 14.9% - 11.1%).In haemodynamically stable patients, there was also a higher mortality when the lactic acid got worse or remained abnormal in the first 24hours (23.8% - 19.2% vs 8.8% - 0%), as well as a higher percentage of MOF (38.1% - 26.9% vs 10.9% - 7.6%).Conclusions The lactic acid results in the first 24hours of the multiple injury patient are associated with mortality and MOF, even when the patient is haemodynamically stable (AU)

[Measurement of lactic acid in multiple injury patients and its usefulness as a predictor of multiorgan failure and mortality]. / Medición del ácido láctico en pacientes politraumatizados y su utilidad como factor predictor de mortalidad y fallo multiorgánico.

INTRODUCTION: The use of lactic acid as marker of occult hyperfusion and its relationship with multiorgan failure (MOF) and/or mortality is a subject of debate. MATERIAL AND METHOD: A prospective study was conducted on multiple injury patients over 16 years of age in critical care areas. The lactic acid was measured at the beginning and at 24 hours of the trauma and associating it with the patient morbidity and mortality. RESULTS: A total of 342 patients, with a mean injury severity score of 24.1, were included. The patients who survived had an initial, and 24 hours after the trauma, lactic acid of 27.8 mg/dl and 17.9 mg/dl, respectively, (normal values less than 22 mg/dl), increasing to 36.5mg/dl and 40.2mg/dl, respectively, in those who died. There were no differences between the initial lactic acid in patients with and without MOF, being increased at 24 hours in those who had MOF (17.8 vs 26.7). The patients with a lactic acid that got worse or remained abnormal at 24 hours had a higher mortality than those in which it remained the same or improved (25% - 17.1% vs 6.3% - 0.8%), with the percentage of patients with MOF also increasing (40.6% - 32.8% vs 14.9% - 11.1%). In haemodynamically stable patients, there was also a higher mortality when the lactic acid got worse or remained abnormal in the first 24 hours (23.8% - 19.2% vs 8.8% - 0%), as well as a higher percentage of MOF (38.1% - 26.9% vs 10.9% - 7.6%). CONCLUSIONS: The lactic acid results in the first 24 hours of the multiple injury patient are associated with mortality and MOF, even when the patient is haemodynamically stable.