Association between hypotension and myocardial injury in patients with severe trauma.
Blood pressure
Hemodynamics
Mean arterial pressure
Multiple trauma
Permissive hypotension
Troponin
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
Feb 2023
Feb 2023
Historique:
received:
25
02
2022
accepted:
30
06
2022
pubmed:
4
8
2022
medline:
16
2
2023
entrez:
3
8
2022
Statut:
ppublish
Résumé
During resuscitation of patients with severe trauma, guidelines recommend permissive hypotension prior to surgical bleeding control. However, hypotension may be associated with reduced organ perfusion and multiple organ dysfunction, e.g. myocardial injury. The association between hypotension and myocardial injury in trauma patients is underexplored. We hypothesized that hypotension is associated with myocardial injury in this population. This retrospective study included patients ≥ 18 years suffering from severe trauma [defined as Injury Severity Score (ISS) ≥ 16] that were treated in the emergency department resuscitation room between 2016 and 2019. Primary endpoint was the incidence of myocardial injury defined as high-sensitive troponin T > 14 ng/l. Main exposure was the duration of arterial hypotension during resuscitation period defined as mean arterial pressure < 65 mmHg. Out of 368 patients screened, 343 were analyzed (73% male, age: 55 ± 21, ISS: 28 ± 12). Myocardial injury was detected in 143 (42%) patients. Overall in-hospital mortality was 26%. Multivariate binary logistic regression with forced entry of nine predefined covariables revealed an odds ratio of 1.29 [95% confidence interval 1.16-1.44]; p = 0.012) for the association between the duration of hypotension and myocardial injury. The duration of hypotension during resuscitation period is independently associated with the incidence of myocardial injury in patients with severe trauma.
Identifiants
pubmed: 35920849
doi: 10.1007/s00068-022-02051-5
pii: 10.1007/s00068-022-02051-5
pmc: PMC9925499
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
217-225Informations de copyright
© 2022. The Author(s).
Références
Unfallchirurg. 2012 Jan;115(1):8-13
pubmed: 22274598
Br J Anaesth. 2018 Oct;121(4):706-721
pubmed: 30236233
Anesth Analg. 2018 Jun;126(6):1936-1945
pubmed: 29077608
Ann Thorac Surg. 2017 Oct;104(4):1289-1297
pubmed: 28935302
Br J Anaesth. 2019 May;122(5):563-574
pubmed: 30916004
Eur Heart J Acute Cardiovasc Care. 2020 Oct 14;:
pubmed: 33620378
Ann Surg. 2000 Nov;232(5):673-9
pubmed: 11066139
JAMA. 2017 Apr 25;317(16):1642-1651
pubmed: 28444280
Kardiol Pol. 2018;76(10):1383-1415
pubmed: 30338834
Anesthesiology. 2004 Dec;101(6):1262-8
pubmed: 15564931
Chest. 1997 Aug;112(2):570-2
pubmed: 9266912
J Trauma Acute Care Surg. 2014 Nov;77(5):780-786
pubmed: 25494433
Anesthesiology. 2017 Jan;126(1):47-65
pubmed: 27792044
Am J Physiol Heart Circ Physiol. 2004 Nov;287(5):H2183-91
pubmed: 15475534
Cardiol Rev. 2019 Nov/Dec;27(6):267-273
pubmed: 30985328
J Trauma. 2005 Nov;59(5):1086-91
pubmed: 16385284
J Clin Epidemiol. 1995 Dec;48(12):1503-10
pubmed: 8543964
Anesth Analg. 2020 Jul;131(1):173-186
pubmed: 31880630
Am J Physiol Heart Circ Physiol. 2007 Sep;293(3):H1847-52
pubmed: 17616742
Anesthesiology. 2016 Jan;124(1):35-44
pubmed: 26540148
J Trauma. 1999 Sep;47(3):474-80
pubmed: 10498300
Eur J Trauma Emerg Surg. 2022 Aug;48(4):3073-3079
pubmed: 34878581
Crit Care. 2016 Apr 12;20:100
pubmed: 27072503
Prehosp Emerg Care. 2018 Jul-Aug;22(4):485-496
pubmed: 29373044