PROGNOSTIC VALUE OF SERIAL SERUM LACTATE LEVELS IN POLY TRAUMA PATIENTS

Dr.Karthikeyan.S; Dr.Saranya Nagalingam; Dr.Balaji Arumugam

Volume : VIII, Issue : III, March - 2019

PROGNOSTIC VALUE OF SERIAL SERUM LACTATE LEVELS IN POLY TRAUMA PATIENTS

Dr. Karthikeyan. S, Dr. Saranya Nagalingam, Dr. Balaji Arumugam

Abstract :

Background: Accurate triage tools such as blood pressure, heart rate, pulse rate, and injury severity score lack the sensitivity to identify at risk trauma patients in Emergency Department. Marker of hypo perfusion such as lactate and base–deficit reflect perfusion defect and being shown to be helpful in the identification of high risk trauma patients. Our aim was to find whether serial blood lactate levels could be predictors of outcome in polytrauma patients. Methods: This is a prosepective analytical study involving all trauma patients admitted to Aarupadai vedu medical college & hospital, puducherry, between December 2008 to July 2010, were included. Injury severity score and Glasgow coma scale score were recorded at admission. Blood Pressure, heart rate arterial blood oxygenation, were obtained and serum lactate levels were measured at admission, 6, 12 and 24 hrs intervals. Patient with lactate levels greater than 2.5 mmol/l underwent invasive monitoring and vigorous resuscitation to correct their lactic acidosis. Results: The Nonsurvivors (n=8) had similar blood lactate levels initially (17.2 � 2.9 mmol/l versus 2 �1 mmol/l) P= 0.002 but had higher levels after 6 hours (4.3 � 0.6 mmol/l versus 2.3 � 0.8mmol/l ) P= 0.07.1(NS) after 12hours( 5.5 � 1.3 mmol/l versus 6.3 � 1.5mmol/l), P= 0.13(NS) and after24 hours( 10.3 � 1.9mmol/l versus 4.5 � 3.3 mmol/l), P= 0.27 as compared with survivors (n =70). There were no significant differences in blood pressure, heart rate, and arterial blood oxygenation , between survivors and Non survivors. Duration of stay categorized into three groups,upto 7 days,8–14 days, 15– 30 days. Among this groups serum lactate levels were compared which was taken initialy at admission and 6th ,12th ,24th hours after admission).Among 78 patients studied, 76 patients showed elevated serum lactate levels at admission and all were subjected to aggressive fluid resuscitation .Inspite of that, there were 8 casualty, 10 cases of Multisystem organ failure and 14 had Respiratory complications within 24 hours of admission. Conclusion: The study showed that the serum lactate levels even though altered initially is not a good prognostic marker for survival of trauma patients