Elsevier

Heart & Lung

Volume 31, Issue 5, September–October 2002, Pages 315-326
Heart & Lung

Issues in Cardiovascular Nursing
Oxygen transport and organ dysfunction in the older trauma patient*,**

https://doi.org/10.1067/mhl.2002.126104Get rights and content

Abstract

Objectives: To determine baseline values of cardiac index (CI) and oxygen transport variables in patients with multiple trauma within 24 hours of admission to a level I trauma center. Method: This project was part of a larger study comparing methods of measuring oxygen consumption (VO2) in 38 severely injured patients. Measurements of CI, oxygen delivery (DO2), and VO2 were performed every 6 hours for 24 hours. Patients were monitored for multiple organ dysfunction syndrome. Results: The mean age was 59 (± 17) years, with 74% (n = 28) of patients 50 years or older. Patients 65 years or older had significantly lower levels of CI, DO2, and VO2. Initial age-related differences in CI (P <.001) persisted at each time period (P <.0136). Younger patients generated a higher DO2 at each time period (P <.0005). Even though there were persistent age-related differences in VO2 over time (P <.0001), no interaction between age and time was found. Survivors had lower scores for multiple organ dysfunction syndrome than did nonsurvivors (P<.0001), all of whom were 50 years or older. Mortality was 21%. Conclusions: All patients were hypermetabolic, but older patients were much less so. Younger patients progressively had increased CI and DO2 levels, whereas older patients started with low levels that remained so. Patients in each age group appeared to lock into a level of VO2 that did not change over time. These findings underscore the vulnerability of older patients to poor outcomes. As the magnitude of the postinjury response is partly age-dependent, future research should differentiate patient characteristics associated with positive outcomes among elderly trauma patients. (Heart Lung® 2002;31:315-26.)

Section snippets

Background

In the past decade, there has been greater recognition that injury afflicts not only the young and that for comparable levels of severity of injury, older trauma patients face longer lengths of hospital stay and greater risks of mortality than do younger patients.1 In 1998, more than 7000 people who were 65 years or older did not survive injuries sustained in motor vehicle crashes, and among them, 83% were occupants of motor vehicles and 16% were pedestrians.2 With the exception of drivers

Methods and instrumentation

The medical center's Nursing Research Committee and the Institutional Review Board approved this study. Informed consent from the patients' legal next of kin was obtained. There were no refusals for consent.

All patients with multiple trauma receiving mechanical ventilation who were admitted to the surgical intensive care unit (SICU) of a verified level I trauma center for 24 months were considered eligible subjects. Specific inclusion criteria included the following: (1) multiple anatomic

Sample descriptives

The sample (N = 38) consisted of 23 men and 15 women. The mean age was 59 ± 17 years (range, 19-85 years). The subjects were categorized by age into 5 groups: 18 to 30 years (n = 3, 8%), 31 to 49 years (n = 7, 19%), 50 to 64 years (n = 8, 21%), 65 to 74 years (n = 13, 34%), and older than 74 years (n = 7, 19%). The majority of patients (74%) were 50 years or older.

Twenty patients (53%) were transported by helicopter from a community hospital to the trauma center, and 6 patients (16%) were

Discussion

This study described baseline values of oxygen transport variables in a homogeneous sample of severely injured patients. No specific intervention to achieve supranormal levels of oxygen transport was performed, and measurements of DO2 and VO2 values were initiated within 24 hours of patients' SICU admission. These patients had undergone initial resuscitation but had not yet received nutritional feedings or developed secondary sequelae, such as septic shock, systemic inflammatory response

Acknowledgements

We thank the critical care nurses of the surgical intensive care units and the respiratory care staff at MetroHealth Medical Center for their ongoing support during this study.

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    *

    Supported in part by AACN Clinical Practice Research Grant awarded by Johnson & Johnson Medical, Inc and the American Association of Critical-Care Nurses.

    **

    Reprint requests: C.D. Epstein, PhD, CS, CCRN, Office 3270, Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106-4904.

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