Safe definitive surgery in polytrauma patients – Lactate alone is not enough for decision making

Abstract text (incl. references and figure legends)

Introduction

Defining treatment strategy in polytrauma patients still is subject to numerous invesitgations and discussions. The goal of this study was to investigate pathophysiologic factors others than lactate as relevant guidance for treatemnt strategies in polytrauma patients

Methods

Retrospective cohort study including polytrauma patients (ISS>16 points) and requriement of ICU. Exclusion: Patients with admission lactate above 2mmol/l. Primary outcome: Complications including pneumonia and mortatliy and imparied pathophysiologic variables with effect on decision making. Variables of interest: coagulopathy, temperature, soft tissue injury.

Reults

Inclusion of 485 patients, mean ISS 22.02 (SD 10.5), mean age 57.4 (SD 20.1) years admission lactate 1.2 (SD 0.4)mmol/l. In 8% of cases patietns had an increased INR (>1.5), in 25.1% of cases patietns had increased coagulation time in ROTEM (above 80sec.), 7.4% of patietns were hypothermic (<35.0°C and 65.6% of patients had relevant soft tissue injuries (AIS >3 of any region). Patients with pathophysiologic coagulopathy had 3.1 higher risk for pneumonia and 2.9 times higher risk for mortality.

Conclusion

Despite normal lactate value, a substantial number of patients presented with hypothermia, coagulopathy, or severe soft tissue injury. These variables are predictive for complications such as pneumonia. lactate alone appears not to be enough for guiding treatment strategy in polytrauma patients.

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