Evgeni Brotfain1, Yoram Klein2, Ronen Toledano3, Leonid Koyfman1, Dmitry Frank1, Micha Y Shamir4, Moti Klein1. 1. Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel. 2. Trauma unit, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel. 3. Clinical Research Center, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel. 4. Department of Anesthesiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Abstract
BACKGROUND: The urine output is an important clinical parameter of renal function and blood volume status, especially in critically ill multiple trauma patients. In the present study, the minute-to-minute urine flow rate and its variability were analyzed in hypotensive multiple trauma patients during the first 6 h of their ICU (intensive care unit) stay. These parameters have not been previously reported. METHODS: The study was retrospective and observational. Demographic and clinical data were extracted from the computerized Register Information Systems. A total of 59 patients were included in the study. The patients were divided into two study groups. Group 1 consisted of 29 multiple trauma patients whose systolic blood pressure was greater than 90 mmHg on admission to the ICU and who were consequently deemed to be hemodynamically compromised. Group 2 consisted of 30 patients whose systolic blood pressure was less than 90 mmHg on admission to the ICU and who were therefore regarded as hemodynamically uncompromised. RESULTS: The urine output and urine flow rate variability during the first 6 h of the patients' ICU stay was significantly lower in group 2 than in group 1 (p < 0.001 and 0.006 respectively). Statistical analysis by the Pearson method demonstrated a strong direct correlation between decreased urine flow rate variability and decreased urine output per hour (R = 0.17; P = 0.009), decreased mean arterial blood pressure (R = 0.24; p = 0.001), and increased heart rate (R = 0.205; p = 0.001). CONCLUSION: These findings suggest that minute-to-minute urine flow rate variability is a reliable incipient marker of hypovolemia and that it should therefore take its place among the parameters used to monitor the hemodynamic status of critically ill multiple trauma patients.
BACKGROUND: The urine output is an important clinical parameter of renal function and blood volume status, especially in critically ill multiple traumapatients. In the present study, the minute-to-minute urine flow rate and its variability were analyzed in hypotensive multiple traumapatients during the first 6 h of their ICU (intensive care unit) stay. These parameters have not been previously reported. METHODS: The study was retrospective and observational. Demographic and clinical data were extracted from the computerized Register Information Systems. A total of 59 patients were included in the study. The patients were divided into two study groups. Group 1 consisted of 29 multiple traumapatients whose systolic blood pressure was greater than 90 mmHg on admission to the ICU and who were consequently deemed to be hemodynamically compromised. Group 2 consisted of 30 patients whose systolic blood pressure was less than 90 mmHg on admission to the ICU and who were therefore regarded as hemodynamically uncompromised. RESULTS: The urine output and urine flow rate variability during the first 6 h of the patients' ICU stay was significantly lower in group 2 than in group 1 (p < 0.001 and 0.006 respectively). Statistical analysis by the Pearson method demonstrated a strong direct correlation between decreased urine flow rate variability and decreased urine output per hour (R = 0.17; P = 0.009), decreased mean arterial blood pressure (R = 0.24; p = 0.001), and increased heart rate (R = 0.205; p = 0.001). CONCLUSION: These findings suggest that minute-to-minute urine flow rate variability is a reliable incipient marker of hypovolemia and that it should therefore take its place among the parameters used to monitor the hemodynamic status of critically ill multiple traumapatients.
Authors: Yoram Klein; Mor Grinstein; Stephen M Cohn; Jacob Silverman; Moti Klein; Hanoch Kashtan; Micha Y Shamir Journal: Anesth Analg Date: 2012-07-04 Impact factor: 5.108
Authors: W Drucker; F Pearce; L Glass-Heidenreich; H Hopf; C Powell; M G Ochsner; H Frankel; D Murray; M Nelson; H Champion; G Rozycki; J Silva; D Malcolm; J DeNobile; D Harviel; N Rich; T K Hunt Journal: J Trauma Date: 1996-03