Evaluation of the role of repeated inferior vena cava sonography in estimating first 24 h fluid requirement in resuscitation of major blunt trauma patients in emergency department Suez Canal University Hospital

• Published in: BMC emergency medicine 2024-07, Vol.24 (1), p.119-13, Article 119
• Main Authors: Ahmed, Rasha Mahmoud, Moussa, Bassant Sayed, Ali, Mohamed Amin, Abo El Sood, Aml Ibrahiem Sayed Ahmed, Labban, Gouda Mohamed El
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Analysis; Blood pressure; Blood transfusion; Blunt trauma; Cold shock; Emergency medical care; Emergency service; Emergency Service, Hospital; Female; Fluid Therapy - methods; Health aspects; Heart beat; Heart rate; Hemodynamics; Hemorrhage; Hemorrhagic shock; Hospitals; Hospitals, University; Humans; Hypovolemic shock; Iran; IVC; Male; Medical research; Medicine, Experimental; Middle Aged; Morbidity; Patients; Population studies; Prospective Studies; Repleted; Resuscitation - methods; Shock; Skin; Statistical analysis; Surveys; Trauma; Ultrasonic imaging; Ultrasonography; Ultrasound; Ultrasound imaging; Vena Cava, Inferior - diagnostic imaging; Wounds, Nonpenetrating - diagnostic imaging; Wounds, Nonpenetrating - therapy; Young Adult
• ISSN: 1471-227X; 1471-227X
• DOI: 10.1186/s12873-024-01033-7

The assessment of hemodynamic status in polytrauma patients is an important principle of the primary survey of trauma patients, and screening for ongoing hemorrhage and assessing the efficacy of resuscitation is vital in avoiding preventable death and significant morbidity in these patients. Invasive procedures may lead to various complications and the IVC ultrasound measurements are increasingly recognized as a potential noninvasive replacement or a source of adjunct information. The study aimed to determine if repeated ultrasound assessment of the inferior vena cava (diameter, collapsibility (IVC- CI) in major trauma patients presenting with collapsible IVC before resuscitation and after the first hour of resuscitation will predict total intravenous fluid requirements at first 24 h. The current study was conducted on 120 patients presented to the emergency department with Major blunt trauma (having significant injury to two or more ISS body regions or an ISS greater than 15). The patients(cases) group (shocked group) (60) patients with signs of shock such as decreased blood pressure  100 b/m, cold, clammy skin, capillary refill > 2 s and their shock index above0.9. The control group (non-shocked group) (60) patients with normal blood pressure and heart rate, no other signs of shock (normal capillary refill, warm skin), and (shock index ≤ 0.9). Patients were evaluated at time 0 (baseline), 1 h after resucitation, and 24 h after 1st hour for:(blood pressure, pulse, RR, SO2, capillary refill time, MABP, IVCci, IVCmax, IVCmin). Among 120 Major blunt trauma patients, 98 males (81.7%) and 22 females (18.3%) were included in this analysis; hypovolemic shocked patients (60 patients) were divided into two main groups according to IVC diameter after the first hour of resuscitation; IVC repleted were 32 patients (53.3%) while 28 patients (46.7%) were IVC non-repleted. In our study population, there were statistically significant differences between repleted and non-repleted IVC cases regarding IVCD, DIVC min, IVCCI (on arrival) (after 1 h) (after 24 h of 1st hour of resuscitation) ( p-value