Resuscitation Endpoints

Published 2004

Recommendations Regarding Improved Patient Outcomes

Level 1

There are insufficient data to formulate a level 1 recommendation.

Level 2

  1. During resuscitation, attempts should be made to increase O2 delivery to normalize base deficit, lactate, or pHi during the first 24 hours. The optimal algorithms for fluid resuscitation, blood product replacement, and the use of inotropes and/or vasopressors have not been determined.

Level 3

Recommendations Regarding Stratifying Physiologic Derangement

Level 1

  1. Standard hemodynamic parameters do not adequately quantify the degree of physiologic derangement in trauma patients. The initial base deficit, lactate level, or gastric pHi should be used to stratify patients with regard to the need for ongoing fluid resuscitation, including packed red blood cells and other blood prod- ucts, and the risks of MODS and death. 

  2. Oxygen delivery parameters should be observed since the ability of a patient to attain supranormal correlates with an improved chance for survival relative to pa- tients who cannot achieve these parameters. 

Level 2

  1. The time to normalization of base deficit, lactate, and pHi is predictive of survival. Observation of at least one of these parameters should be used clinically for prognostication. 

  2. Persistently high base deficit or low pHi (or worsening of these parameters) may be an early indicator of complications, e.g., ongoing hemorrhage or abdominal compartment syndrome. These findings should prompt rapid reassessment of the patient.

  3. The effects of ethanol intoxication, seizures, sepsis, a hyperchloremic metabolic acidosis, or a pre-existing metabolic acidosis, as well as administration of sodium bicarbonate, on base deficit levels should be considered when using this parameter as an endpoint of resuscitation. 

Level 3

  1. Right ventricular end diastolic volume index (RVEDVI) measurement may be utilized as a better indicator of adequate volume resuscitation (preload) than central venous pressure or pulmonary capillary wedge pressure (PCWP). 

  2. Measurements of tissue (subcutaneous or muscle) O2 and/or CO2 levels may be used to identify patients who require additional resuscitation and are at an increased risk for MODS and death. 

  3. Serum bicarbonate levels may be substituted for base deficit levels.