Accident-related deaths is the 7th leading cause of death in Taiwan, and most of them is due to trauma from falls and traffic accident. Among trauma patients, the common cause of death is from hemorrhagic shock. Thus, real-time and accurate blood pressure monitoring is important for trauma patients. Incorrect blood pressure monitoring can lead to adverse events like traumatic cardiac arrest and shock and can also delay the time for intervention (fluid resuscitation, blood transfusion and operation). The current practice of blood pressure monitoring in trauma patient is by non-invasive blood pressure monitoring, which may be incorrect and not timely. Patient's body type and peripheral perfusion can both influence the result of non-invasive blood pressure monitoring. With continuous and correct blood pressure monitoring, the resuscitation team can give adequate and timely treatment. In some trauma centers, arterial line insertion in trauma patients is a daily practice, while the evidence is inadequate and the potential benefit in unknown. The main purpose of this study is to investigate the application of arterial line insertion in trauma patients. The study design is a prospective before-after study to exam whether arterial line insertion in trauma patients can reduce adverse event rate like hypovolemic shock and improve patient's outcomes.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
216
insert arterial line for patients who meet major trauma criteria
National Taiwan University Hospital Yunlin Branch
Douliu, Taiwan
composite primary endpoint (including any hypotension, vasopressors usage, any cardiac arrest in ER, Shock index )
including any hypotension, vasopressors usage, any cardiac arrest in ER, Shock index (HR/SBP)\>1
Time frame: during ER stay, up to 6 hours
prolong ICU admission
define as \> 6 days of admission
Time frame: up to 7 days
30 days mortality rate
mortality within 30 days of trauma event
Time frame: mortality within 30 days of trauma event
volume of fluid administration
any type of fluid administration
Time frame: during ER stay, up to 6 hours
Area under curve (AUC) difference under different time measuring frequency
We will use continuous blood pressure data and apply different intervals (1, 3, 5, and 10 minutes) to create a plot, then smooth it to calculate the area under the curve (AUC).
Time frame: 1/3/5/10 minutes
units of red blood cell transfusion
units of red blood cell transfusion
Time frame: during ER stay, up to 6 hours
arterial blood pressure trajectory
We will depict the arterial blood pressure trajectory for each patient.
Time frame: during ER stay, up to 6 hours
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