Old and young trauma patients are capable of hyperdynamic response during standardized shock resuscitation.
The responses of old and young trauma patients resuscitated using a standardized protocol are compared in an inception cohort study. A standardized resuscitation protocol was used to attain and maintain an oxygen delivery index of 600 mL/min · m2 or greater (DO2 I≥600) for the first 24 hours in the intensive care unit. Interventions, responses, and outcomes for old (≥65 years) and young (<65 years) patients are described. Data were analyzed using analysis of variance, the χ2 test, and the t test; P <.05 was considered significant.
A 20-bed shock trauma intensive care unit in a regional level I trauma center.
Patients at high risk of postinjury multiple organ failure, ie, major organ or vascular injury and/or skeletal fractures, initial base deficit of 6 mEq/L or greater, need for 6 units or more of packed red blood cells in the first 12 hours, or age of 65 years or older with any 2 previous criteria.
Pulmonary artery catheter, crystalloid fluid infusion, packed red blood cell transfusion, and moderate inotrope support, as needed in that sequence, to attain DO2 I≥600.
Main Outcome Measures
Intensive care unit length of stay and survival.
During 19 months ending June 1999, 12 old patients (58% male; age, 76 ± 2 years [mean±SEM] [P <.001]; Injury Severity Score, 20 ± 2 [P =.02]) and 54 young patients (61% male; age, 37 ± 2 years; Injury Severity Score, 32 ± 2) were resuscitated. Initially, for old patients (cardiac index, 2.0 ± 0.2 L/min · m2 ) and for young patients (cardiac index, 3.0 ± 0.2 L/min · m2 ;P =.01), 24-hour volumes were as follows: 16 ± 3 L of crystalloid and 12 ± 3 units of packed red blood cells for the old patients and 21 ± 2 L of crystalloid and 19 ± 2 units of packed red blood cells for the young patients. For old patients, 9 (75%) attained DO2 I≥600, and 11 (92%) survived 7 or more days and 5 (42%) 30 or more days. For young patients, 45 (83%) attained the DO2 I goal, and 48 (89%) survived 30 or more days. Intensive care unit length of stay was 25 ± 9 days for the old patients and 23 ± 2 days for the young patients.
Elderly patients have initially depressed cardiac index but generate hyperdynamic response. Although ultimate outcome is poorer than in the younger cohort, resuscitation is not futile.