Künt Gövde Travmalı Hastalarda İnferior Vena Cava Düzlük İndeksinin Erken Hipovolemik Şoktaki Rolü

Yıl 2022, Cilt: 55 Sayı: 2, 116 - 119, 31.08.2022

Nezih Kavak , Nurcan Ertan Ahmet Seki , Meltem Özdemir , Rasime Pelin Kavak

https://doi.org/10.20492/aeahtd.1072483

Öz

AMAÇ: Amacımız künt gövde travmalı hastalarda vena kava inferior (VCI) düzlük indeksinin erken hipovolemik şokdaki rolünü değerlendirmektir.
GEREÇ VE YÖNTEM: Bilgisayarlı tomografi (BT) taramasında düzlük indeksi 2'nin altında olan hastalar düzleşmiş VCI’lu hastalar, 2 veya üstünde olanlar düzleşmemişVCI’lu hastalar olarak kabul edildi. Düzleşmiş VCI’lu hastalar ve düzleşmemiş VCI’lu hastaların demografik verileri, komorbiditeleri, travma mekanizması, Yaralanma Ciddiyet Skoru (YCS), Glasgow Koma Skoru (GKS), laktat düzeyi, baz fazlalığı, şok indeksi (SI), 24 saat içindeki klinik sonuçları ve mortalite karşılaştırıldı.
BULGULAR: 116 (30,6%) hasta düzleşmiş VCI’lu, 263 hasta (69,4%) düzleşmemiş VCI’lu idi. Düzleşmiş VCI’lu hastalar ve düzleşmemiş VCI’lu hastalar arasında yaş, cinsiyet, komorbitite ve travma mekanizması açısından anlamlı farklıklık saptanmadı (p>0.05). Düzleşmiş VCI’lu hastaların SI değeri 0,9 ve üzerindeydi (p<0,001). Düzleşmiş VCI’lu hastaların YCS'si daha yüksekti (p<0,001). Düzleşmiş VCI’lu hastalar ve düzleşmemiş VCI’lu hastalarında GCS skoru açısından fark yoktu (p>0.05). Düzleşmiş VCI’lu hastalarda laktat düzeyi daha yüksek bulundu (p<0,001). Düzleşmiş VCI’lu hastalarındaki baz fazlalığı, düzleşmiş VCI’lu hastalara göre daha düşük bulundu (p<0,001). Düzleşmiş VCI’lu hastalarda volüm replasmanı, operasyon, hastaneye yatış ve hastane mortalitesi daha yüksekti (p<0,001). Hastaların VCI düzlük indeksi ile laktat değeri ve YCS arasında negatif (sırasıyla r=-0.353 p<0.001; r=-0.702 p<0.001), baz fazlalığı arasında ise pozitif korelasyon bulundu. (r=0.656; p<0.001).
SONUÇ: Künt gövde travmalı hastaların ilk BT incelemesinde VCI düzlük indeks’i erken hipovolemik şok ile ilişkilidir. VCI düzlük indeks’inin intravasküler volüm değerlendirilmesinde yol gösterici olabileceğini düşünmekteyiz.

Anahtar Kelimeler

künt travma, bilgisayarlı tomografi, inferior vena kava

The Role of Flatness Index of Inferior Vena Cava in Early Hypovolemic Shock Concerning Blunt Torso Trauma Patients

Öz

AIM: Our aim is to evaluate the role of flatness of index of Inferior Vena Cava (IVC) with early hypovolemic shock in blunt torso trauma patients.
MATERIAL AND METHOD: In the computed tomography (CT) scan, patients with flatness index below 2 were considered as flat IVC patients, and those with 2 or more were considered as non-flattened IVC patients. Demographic data, comorbidities, trauma mechanism, Injury Severity Score (ISS), Glasgow Coma Score (GCS), lactate level, base excess, shock index (SI), clinical outcomes within 24 hours, and mortality of the flat IVC patients and non-flattened IVC patients were compared.
RESULTS: 116 (30.6%) were found to have a flat IVC and 263 (69.4%) patients were found to have a non-flattened IVC. There was no significant difference between flat IVC patients and non-flattened IVC patients in terms of age, gender, comorbidity, and trauma mechanism (p>0.05). Flat IVC patients had a higher SI of 0.9 and above (p<0.001). ISS of flat IVC patients was higher (p<0.001). There was no difference in GCS score between patients with a flat IVC and patients with a non-flattened IVC (p>0.05). Lactate level was found to be higher in flat IVC patients (p<0.001). Base excess in flat IVC patients was found inferior to that of non-flattened IVC patients (p<0.001). Volume replacement, operation, hospitalization, and hospital mortality were higher in patients with flat IVC (p<0.001). A negative correlation was found between the patients' flatness index of IVC and, lactate level and ISS (r=-0.353 p<0.001; r=-0.702 p<0.001, respectively), and a positive correlation was found between the base excess. (r=0.656; p<0.001).
CONCLUSION: In the initial CT scan of blunt torso trauma patients, the flatness of the IVC index is associated with early hypovolemic shock. The flatness of the IVC index can be used as a guide in the evaluation of intravascular volume in these patients.

Anahtar Kelimeler

blunt travma, computed tomogarphy, inferior vena cava

Kaynakça

• 1. Cortés-Samacá CA, Meléndez-Flórez HJ, Robles SA, et al. Base deficit, lactate clearance, and shock index as predictors of morbidity and mortality in multiple-trauma patients. Rev Colomb Anestesiol. 2018; 46: 208–215
• 2. Chien CY, Yan JL, Han ST, et al. Inferior Vena Cava Volume Is an Independent Predictor of Massive Transfusion in Patients With Trauma. J Intensive Care Med. 2021;36(4):428-435. doi:10.1177/0885066619894556
• 3. Elst J, Ghijselings IE, Zuidema WP, Berger FH. Signs of post-traumatic hypovolemia on abdominal CT and their clinical importance: A systematic review. Eur J Radiol. 2020;124:108800. doi:10.1016/j.ejrad.2019.108800
• 4. Radomski M, Agnihothri R, Knapp S, et al. Inferior vena cava size is not associated with shock following injury. J Trauma Acute Care Surg. 2014;77(1):34-39. doi:10.1097/TA.0000000000000248
• 5. Koch E, Lovett S, Nghiem T, Riggs RA, Rech MA. Shock index in the emergency department: utility and limitations. Open Access Emerg Med. 2019;11:179-199. Published 2019 Aug 14. doi:10.2147/OAEM.S178358
• 6. Matsumoto S, Sekine K, Yamazaki M, et al. Predictive value of a flat inferior vena cava on initial computed tomography for hemodynamic deterioration in patients with blunt torso trauma. J Trauma. 2010;69(6):1398-1402. doi:10.1097/TA.0b013e3181fc406f
• 7. Bilgin S, Topal FE, Yamanoğlu A, et al. Effect of Changes in Intravascular Volume on Inferior Vena Cava and Aorta Diameters and the Caval/Aorta Index in Healthy Volunteers. J Ultrasound Med. 2020;39(2):231-238. doi:10.1002/jum.15093
• 8. Johnson JJ, Garwe T, Albrecht RM, et al. Initial inferior vena cava diameter on computed tomographic scan independently predicts mortality in severely injured trauma patients. J Trauma Acute Care Surg. 2013;74(3):741-746. doi:10.1097/TA.0b013e3182827270
• 9. Taylor GA, Fallat ME, Eichelberger MR. Hypovolemic shock in children: abdominal CT manifestations. Radiology. 1987;164(2):479-481. doi:10.1148/radiology.164.2.3602389
• 10. Jeffrey RB Jr, Federle MP. The collapsed inferior vena cava: CT evidence of hypovolemia. AJR Am J Roentgenol. 1988;150(2):431-432. doi:10.2214/ajr.150.2.431
• 11. Li Y, Zhang LY, Wang Y, Zhang WG. The flatness index of inferior vena cava is useful in predicting hypovolemic shock in severe multiple-injury patients. J Emerg Med. 2013;45(6):872-878. doi:10.1016/j.jemermed.2013.04.036
• 12. Smillie RP, Shetty M, Boyer AC, Madrazo B, Jafri SZ. Imaging evaluation of the inferior vena cava. Radiographics. 2015;35(2):578-592. doi:10.1148/rg.352140136
• 13. Mirvis SE, Shanmuganathan K, Erb R. Diffuse small-bowel ischemia in hypotensive adults after blunt trauma (shock bowel): CT findings and clinical significance. AJR Am J Roentgenol. 1994;163(6):1375-1379. doi:10.2214/ajr.163.6.7992732
• 14. Smithson L, Morrell J, Kowalik U, Flynn W, Guo WA. Correlation of computed tomographic signs of hypoperfusion and clinical hypoperfusion in adult blunt trauma patients. J Trauma Acute Care Surg. 2015;78(6):1162-1167. doi:10.1097/TA.0000000000000623
• 15. Miraflor E, Yeung L, Strumwasser A, Sadjadi J, Victorino GP. Correlation between IVC dimensions and volume status on CT scan. J Surg Res. 2011;170(2):291-296. doi:10.1016/j.jss.2011.03.057
• 16. Arslan CE, Yesilaras M, Atilla OD. Does flattened IVC on CT can show hypovolemia in trauma patients?. Anatolian J Emerg Med. 2020; 3(1); 1-5.
• 17. Nguyen A, Plurad DS, Bricker S, et al. Flat or fat? Inferior vena cava ratio is a marker for occult shock in trauma patients. J Surg Res. 2014;192(2):263-267. doi:10.1016/j.jss.2014.06.052
• 18. Kohli-Seth R, Neuman T, Sinha R, Bassily-Marcus A. Use of echocardiography and modalities of patient monitoring of trauma patients. Curr Opin Anaesthesiol. 2010;23(2):239-245. doi:10.1097/ACO.0b013e328335f007
• 19. Yazlamaz NO, Ozakin E, Bastug BT, et al. The Flatness Index of Inferior Vena Cava can be an Accurate Predictor for Hypovolemia in Multi-Trauma Patients. Prehosp Disaster Med. 2021;36(4):414-420. doi:10.1017/S1049023X21000418
• 20. Salottolo KM, Mains CW, Offner PJ, Bourg PW, Bar-Or D. A retrospective analysis of geriatric trauma patients: venous lactate is a better predictor of mortality than traditional vital signs. Scand J Trauma Resusc Emerg Med. 2013;21:7. Published 2013 Feb 14. doi:10.1186/1757-7241-21-7
• 21. Ahun E, Köksal Ö, Sığırlı D, Torun G, Dönmez SS, Armağan E. Value of the Glasgow coma scale, age, and arterial blood pressure score for predicting the mortality of major trauma patients presenting to the emergency department. Ulus Travma Acil Cerrahi Derg. 2014;20(4):241-247. doi:10.5505/tjtes.2014.76399
• 22. Liao YY, Lin HJ, Lu YH, Foo NP, Guo HR, Chen KT. Does CT evidence of a flat inferior vena cava indicate hypovolemia in blunt trauma patients with solid organ injuries?. J Trauma. 2011;70(6):1358-1361. doi:10.1097/TA.0b013e3181f31e37
• 23. Davis JW, Sue LP, Dirks RC, et al. Admission base deficit is superior to lactate in identifying shock and resuscitative needs in trauma patients. Am J Surg. 2020;220(6):1480-1484. doi:10.1016/j.amjsurg.2020.10.005