BACKGROUND: Geriatric trauma populations respond differently than younger trauma populations. Critical Care Ultrasound (CCUS) can guide resuscitation, and it has been shown to decrease intravenous fluid (IVF), lower time until operation, and lower mortality in trauma. CCUS guided resuscitation has not yet been studied in geriatric trauma. We hypothesized that incorporation of CCUS would decrease amount of IVF administered, decrease time to initiation of vasopressors, and decrease end organ dysfunction. METHODS: A PRE-CCUS geriatric trauma group between January 2015 and October 2016 was resuscitated per standard practice. A POST-CCUS group between January 2017 and December 2018 was resuscitated based on CCUS performed by trained intensivist upon admission to the ICU and 6 hours after initial ultrasound. The PRE-CCUS and POST-CCUS groups underwent propensity score matching, yielding 60 enrollees in each arm. Retrospective review was conducted for demographics, clinical outcomes, and primary endpoints including amount of IVF in the first 48 hours, duration to initiation of vasopressor use, and end organ dysfunction. Wilcoxon two-sample, chi-square tests, and Kappa statistics were performed to check associations between groups. RESULTS: There was no statistical difference between PRE-CCUS and POST-CCUS demographics and ISS scores. IVF within 48 hours decreased from median [interquartile range] 4941 mL[4019 mL] in the PRE- to 2633 mL[3671 mL] in the POST- (p = 0.0003). There was no significant difference between the two groups in time to initiation of vasopressors, vasopressor duration, lactate clearance, ICU length of stay (LOS), or hospital LOS. There was a significant decrease in ventilator days, with 26.7% PRE-CCUS with ventilation >2 days, and only 6.7% POST-CCUS requiring ventilation >2 days (p = 0.0033). CONCLUSIONS: CCUS can be a useful addition to geriatric resuscitation. The POST- received less IV fluid and had decreased ventilator days. While mortality, lactate clearance, complications, and hospital stay were not statistically different, there was a perception that CCUS was a useful adjunct for assessing volume status and cardiac function. LEVEL OF EVIDENCE: Level II.
BACKGROUND: Geriatric trauma populations respond differently than younger trauma populations. Critical Care Ultrasound (CCUS) can guide resuscitation, and it has been shown to decrease intravenous fluid (IVF), lower time until operation, and lower mortality in trauma. CCUS guided resuscitation has not yet been studied in geriatric trauma. We hypothesized that incorporation of CCUS would decrease amount of IVF administered, decrease time to initiation of vasopressors, and decrease end organ dysfunction. METHODS: A PRE-CCUS geriatric trauma group between January 2015 and October 2016 was resuscitated per standard practice. A POST-CCUS group between January 2017 and December 2018 was resuscitated based on CCUS performed by trained intensivist upon admission to the ICU and 6 hours after initial ultrasound. The PRE-CCUS and POST-CCUS groups underwent propensity score matching, yielding 60 enrollees in each arm. Retrospective review was conducted for demographics, clinical outcomes, and primary endpoints including amount of IVF in the first 48 hours, duration to initiation of vasopressor use, and end organ dysfunction. Wilcoxon two-sample, chi-square tests, and Kappa statistics were performed to check associations between groups. RESULTS: There was no statistical difference between PRE-CCUS and POST-CCUS demographics and ISS scores. IVF within 48 hours decreased from median [interquartile range] 4941 mL[4019 mL] in the PRE- to 2633 mL[3671 mL] in the POST- (p = 0.0003). There was no significant difference between the two groups in time to initiation of vasopressors, vasopressor duration, lactate clearance, ICU length of stay (LOS), or hospital LOS. There was a significant decrease in ventilator days, with 26.7% PRE-CCUS with ventilation >2 days, and only 6.7% POST-CCUS requiring ventilation >2 days (p = 0.0033). CONCLUSIONS:CCUS can be a useful addition to geriatric resuscitation. The POST- received less IV fluid and had decreased ventilator days. While mortality, lactate clearance, complications, and hospital stay were not statistically different, there was a perception that CCUS was a useful adjunct for assessing volume status and cardiac function. LEVEL OF EVIDENCE: Level II.