Blunt trauma resuscitation - The old can respond

Hypothesis: Old and young trauma patients are capable of hyperdynamic respo nse 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 standar dized resuscitation protocol was used to attain and maintain an oxygen deli very index of 600 mL/min . m(2) or greater (DO2I/600) for the first 24 hour s in the intensive care unit. Interventions, responses, and outcomes for ol d (greater than or equal to 65 years) and young (<65 years) patients are de scribed. Data were analyzed using analysis of variance, the chi(2) test, an d the t test; P<.05 was considered significant. Setting: A 20-bed shock trauma intensive care unit in a regional level I tr auma center. Patients: Patients at high risk of postinjury multiple organ failure, ie, m ajor organ or vascular injury and/or skeletal fractures, initial base defic it of 6 mEq/L or greater, need for 6 units or more of packed red blood cell s in the first 12 hours, or age of 65 years or older with any 2 previous cr iteria. Interventions: Pulmonary artery catheter, crystalloid fluid infusion, packe d red blood cell transfusion, and moderate inotrope support, as needed in t hat sequence, to:attain DO2I greater than or equal to 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 in dex, 2.0 +/- 0.2 L/min . m(2)) and for young patients (cardiac index, 3.0 /- 0.2 L/min . m(2); 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 patie nts and 21 +/- 2 L of crystalloid and 19 +/- 2 units of packed red blood ce lls for the young patients. For old patients, 9 (75%) attained DO2I greater than or equal to 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 ge nerate hyperdynamic response. Although ultimate outcome is poorer than in t he younger cohort, resuscitation is not futile.