Abstract 337: Plasma Oncotic Pressure Is Reduced in Transfused Trauma Patients
Objective: Hemorrhagic shock is the leading cause of potentially preventable traumatic death. Many of these deaths are believed to be avoidable with appropriate resuscitation. We investigated the role of initial plasma colloid osmotic presure (COP, i.e. oncotic pressure) on outcomes in trauma patients.
Methods: Plasma samples were collected from 10 healthy consented volunteers and 27 patients (TRPs) upon admission to the emergency department (ED). Biophysical properties of plasma including osmolality, COP, and serum protein were measured and correlated to clinical data. Initial vital signs, routine laboratory values, type and volume of resuscitative fluids were recorded 24 hours post-ED admission as was length of hospital stay.
Results: COP was significantly reduced in TRPs compared to controls 17.7±2.6 vs 20.7±2.1 mmHg (p<0.05). COP strongly correlated (R2=0.8) to serum protein values, 6.1±0.8 in TRPs compared to controls, 6.6±0.4 g/dL. COP in TRPs were further categorized into Low (L<15.3 mmHg, N=7), Moderate (M=15.3-19.3 mmHg, N=13) and Normal COP (N>19.3 mmHg, N=6) subgroups, based on the interquartile range. TRPs with low and moderate COP had similar heart rates, systolic and diastolic blood pressures (128/75 mmHg, HR=94); whereas TRPs with N COP had higher blood pressures (148/93 mmHg). TRPs with L COP also received more blood transfusions within the first 24 hours of admission (L=1340±1568 ml, M=131±316 ml, and N=0 ml). Crystalloid infusions during the first 24 hours were similar among all groups (L=1480±1051 ml, M=1130±1040 ml, N=1171±965 ml). TRPs with L COP had longer hospital stays than M and N COP groups (13.5 vs. 7 days).
Conclusions: Reduced COP and protein levels in TRPs are indicative of injury and hemorrhage. TRPs with low COP were more likely to receive blood transfusions during the first 24 hours and had longer hospital stays despite having similar vital signs as the M and N COP groups. In the absence of significant alterations in blood pressures and heart rate, COP and protein levels were indicative of a requirement for blood transfusions. We believe that using COP and protein levels in conjunction with current protocols could potentially improve resuscitation strategies for trauma patients.
- © 2012 by American Heart Association, Inc.