This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Citing articles on ISI (22)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Aging/ Geriatrics  • Alert me on articles by topic

The Old Can Respond

Bruce A. McKinley, PhD; Robert G. Marvin, MD; Christine S. Cocanour, MD; Alicia Marquez, RN; Drue N. Ware, MD; Frederick A. Moore, MD

Arch Surg. 2000;135:688-695.

Hypothesis  Old and young trauma patients are capable of hyperdynamic response during standardized shock resuscitation.

Design  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 (DO₂I≥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 ² test, and the t test; P<.05 was considered significant.

Setting  A 20-bed shock trauma intensive care unit in a regional level I trauma center.

Patients  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.

Interventions  Pulmonary artery catheter, crystalloid fluid infusion, packed red blood cell transfusion, and moderate inotrope support, as needed in that sequence, to attain DO₂I≥600.

Main Outcome Measures  Intensive care unit length of stay and survival.

Results  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 DO₂I≥600, and 11 (92%) survived 7 or more days and 5 (42%) 30 or more days. For young patients, 45 (83%) attained the DO₂I 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.

Conclusions  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.

From the Departments of Anesthesiology (Dr McKinley) and Surgery (Drs Marvin, Cocanour, Ware, and Moore), University of Texas–Houston Medical School, and Shock Trauma Intensive Care Unit, Memorial Hermann Hospital, Houston (Ms Marquez).

RELATED ARTICLE

Archives of Surgery Reader's Choice: Continuing Medical Education
Arch Surg. 2000;135(6):744-745.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Supranormal Trauma Resuscitation Causes More Cases of Abdominal Compartment Syndrome
Balogh et al.
Arch Surg 2003;138:637-643.
ABSTRACT | FULL TEXT