Dados do Trabalho

Título

Lactate or Base Deficit as a maker of acidosis and mortality in traumatic hemorrhagic shock?

Objetivo

To compare Base Deficit (BD) and lactate values, at Intensive Care Unit (ICU) admission and 24 hours later, as predictors of metabolic acidosis and mortality.

Métodos

Cohort of trauma patients, over 18 years old, undergoing damage control surgery on admission, with ICU admission, between January 2012 and December 2018. We analysed Injury Severity Score, mechanism and type of trauma, BD, lactate, pH and bicarbonate collected at ICU admission and 24 hours later, and mortality. Patients were divided into groups of BD values (≥ -6 and < -6), as described in the literature, or divided according to the best accuracy values found in the study (-10.35 at ICU admission and -8.65 24 hours later). In both situations, patients were also divided into subgroups according to the moment of analysis (admission to the ICU and 24 hours later). Comparisons were performed using Student-T, Fischer's exact and nonparametric Mann-Whitney tests. The comparison between BD and lactate used the ROC curve.

Resultados

Impacting perfusion alterations were already found at ICU admission (mean lactate: 4.83; mean BD: -10.15; mean pH: 7.23 and mean BIC: 16.7). Predicted mortality using BD maintained statistical significance in both scenarios – from the literature and the one applied in this study.

Conclusão

The most accurate BD values calculated in this study were higher than those previously described and were still able to predict the presence of tissue hypoperfusion, acidosis and mortality at the two studied moments. It has good performance as a bedside marker, with quick results and wide available.