HEMODYNAMIC RESPONSES IN TRAUMA PATIENTS: A STUDY ON EARLY PHYSIOLOGIC AND PATHOLOGIC PREDICTOR OF SHOCK
Main Article Content
Keywords
Shock, Early Predictors, Lactate Levels, Multi-Organ Dysfunction, Vasopressor Therapy, Histopathology, Critical Care Outcomes
Abstract
Background Shock is a severe medical condition resulting from inadequate tissue perfusion, leading to multi-organ dysfunction and high mortality rates. Early identification of physiological and pathological predictors is crucial for timely intervention and improved patient outcomes. Despite advancements in critical care, shock remains a leading cause of hospital mortality, necessitating further research into reliable early indicators.
MethodologyThis prospective observational study was conducted at Jinnah Medical College from January 2023 to January 2024, including 104 patients diagnosed with shock. Clinical parameters, laboratory markers, and histopathological findings were recorded and analyzed. Physiological indicators such as heart rate, blood pressure, and oxygen saturation were evaluated alongside biochemical markers like lactate levels, inflammatory markers, and coagulation profiles. Histopathological examinations were performed on deceased patients to assess organ damage.
ResultsFindings indicated that elevated lactate levels, tachycardia, advanced age, and the presence of comorbidities were significantly associated with poor patient outcomes. Histopathological analysis revealed myocardial necrosis, diffuse alveolar damage, and acute tubular necrosis in non-survivors, highlighting the extent of multi-organ dysfunction in fatal cases. Septic shock patients exhibited the highest requirement for vasopressor support, reflecting severe circulatory compromise. Early recognition of these parameters was critical in predicting disease severity and guiding clinical management.
Conclusion This study underscores the importance of early physiological and pathological indicators in predicting shock outcomes. Elevated lactate levels, cardiac stress markers, and multi-organ dysfunction were key predictors of mortality. Timely identification and targeted therapeutic interventions can significantly improve patient survival. Future research should focus on refining predictive models, integrating novel biomarkers, and optimizing individualized treatment strategies to enhance shock management in critical care settings.
MethodologyThis prospective observational study was conducted at Jinnah Medical College from January 2023 to January 2024, including 104 patients diagnosed with shock. Clinical parameters, laboratory markers, and histopathological findings were recorded and analyzed. Physiological indicators such as heart rate, blood pressure, and oxygen saturation were evaluated alongside biochemical markers like lactate levels, inflammatory markers, and coagulation profiles. Histopathological examinations were performed on deceased patients to assess organ damage.
ResultsFindings indicated that elevated lactate levels, tachycardia, advanced age, and the presence of comorbidities were significantly associated with poor patient outcomes. Histopathological analysis revealed myocardial necrosis, diffuse alveolar damage, and acute tubular necrosis in non-survivors, highlighting the extent of multi-organ dysfunction in fatal cases. Septic shock patients exhibited the highest requirement for vasopressor support, reflecting severe circulatory compromise. Early recognition of these parameters was critical in predicting disease severity and guiding clinical management.
Conclusion This study underscores the importance of early physiological and pathological indicators in predicting shock outcomes. Elevated lactate levels, cardiac stress markers, and multi-organ dysfunction were key predictors of mortality. Timely identification and targeted therapeutic interventions can significantly improve patient survival. Future research should focus on refining predictive models, integrating novel biomarkers, and optimizing individualized treatment strategies to enhance shock management in critical care settings.
References
1. Tavazzi G, Spiegel R, Rola P, Price S, Corradi F, Hockstein M. Multiorgan evaluation of perfusion and congestion using ultrasound in patients with shock. European Heart Journal: Acute Cardiovascular Care. 2023;12(5):344-52.
2. Duque P, Calvo A, Lockie C, Schöchl H. Pathophysiology of trauma-induced coagulopathy. Transfusion medicine reviews. 2021;35(4):80-6.
3. Hu H, Li L, Zhang Y, Sha T, Huang Q, Guo X, et al. A prediction model for assessing prognosis in critically ill patients with sepsis-associated acute kidney injury. Shock. 2021;56(4):564-72.
4. Ceglarek U, Schellong P, Rosolowski M, Scholz M, Willenberg A, Kratzsch J, et al. The novel cystatin C, lactate, interleukin-6, and N-terminal pro-B-type natriuretic peptide (CLIP)-based mortality risk score in cardiogenic shock after acute myocardial infarction. European heart journal. 2021;42(24):2344-52.
5. Kanwar MK, Everett KD, Gulati G, Brener MI, Kapur NK. Epidemiology and management of right ventricular-predominant heart failure and shock in the cardiac intensive care unit. European Heart Journal: Acute Cardiovascular Care. 2022;11(7):584-94.
6. Rittgerodt N, Pape T, Busch M, Becker LS, Schneider A, Wedemeyer H, et al. Predictors of response to intra-arterial vasodilatory therapy of non-occlusive mesenteric ischemia in patients with severe shock: results from a prospective observational study. Critical Care. 2022;26(1):92.
7. Sanchez EC, Pinsky MR, Sinha S, Mishra RC, Lopa AJ, Chatterjee R. Fluids and Early Vasopressors in the Management of Septic Shock: Do We Have the Right Answers Yet? The Journal of Critical Care Medicine. 2023;9(3):138-47.
8. Jentzer JC, Burstein B, Van Diepen S, Murphy J, Holmes Jr DR, Bell MR, et al. Defining shock and preshock for mortality risk stratification in cardiac intensive care unit patients. Circulation: Heart Failure. 2021;14(1):e007678.
9. Palitsky R, Da’Mere TW, Friedman SE, Ruiz JM, Sullivan D, O’Connor M-F. The relationship of prolonged grief disorder symptoms with hemodynamic response to grief recall among bereaved adults. Psychosomatic Medicine. 2023;85(6):545-50.
10. Bauer SR, Sacha GL, Lam SW, Wang L, Reddy AJ, Duggal A, et al. Hemodynamic response to vasopressin dosage of 0.03 units/min vs. 0.04 units/min in patients with septic shock. Journal of intensive care medicine. 2022;37(1):92-9.
11. SHAH P, SHAH A, DESAI R, AGRAWAL A. Assessing Reverse Shock Index as a Survival Predictor for Trauma Patients in Emergency Settings: A Retrospective Observational Study. Journal of Clinical & Diagnostic Research. 2024;18(5).
12. Bataille B, de Selle J, Moussot P-E, Marty P, Silva S, Cocquet P. Machine learning methods to improve bedside fluid responsiveness prediction in severe sepsis or septic shock: an observational study. British journal of anaesthesia. 2021;126(4):826-34.
13. Mathew R, Fernando SM, Hu K, Parlow S, Di Santo P, Brodie D, et al. Optimal perfusion targets in cardiogenic shock. JACC: Advances. 2022;1(2):100034.
14. Bauer SR, Sacha GL, Siuba MT, Lam SW, Reddy AJ, Duggal A, et al. Association of arterial pH with hemodynamic response to vasopressin in patients with septic shock: an observational cohort study. Critical Care Explorations. 2022;4(2):e0634.
15. Gupta CB, Basu D, Williams TK, Neff LP, Johnson MA, Patel NT, et al. Improving the precision of shock resuscitation by predicting fluid responsiveness with machine learning and arterial blood pressure waveform data. Scientific Reports. 2024;14(1):2227.
16. Sern Lim H. Cardiac power output index to define hemodynamic response to Impella support in cardiogenic shock. The International journal of artificial organs. 2022;45(7):598-603.
17. Bonanno FG. Management of Hemorrhagic Shock According to the Revised “Physiological Classification”-Update 2024. 2024.
18. Jentzer JC, Wiley BM, Anavekar NS, Pislaru SV, Mankad SV, Bennett CE, et al. Noninvasive hemodynamic assessment of shock severity and mortality risk prediction in the cardiac intensive care unit. Cardiovascular Imaging. 2021;14(2):321-32.
19. Fecher A, Stimpson A, Ferrigno L, Pohlman TH. The pathophysiology and management of hemorrhagic shock in the polytrauma patient. Journal of clinical medicine. 2021;10(20):4793.
20. Kashani K, Omer T, Shaw AD. The intensivist's perspective of shock, volume management, and hemodynamic monitoring. Clinical Journal of the American Society of Nephrology. 2022;17(5):706-16.
2. Duque P, Calvo A, Lockie C, Schöchl H. Pathophysiology of trauma-induced coagulopathy. Transfusion medicine reviews. 2021;35(4):80-6.
3. Hu H, Li L, Zhang Y, Sha T, Huang Q, Guo X, et al. A prediction model for assessing prognosis in critically ill patients with sepsis-associated acute kidney injury. Shock. 2021;56(4):564-72.
4. Ceglarek U, Schellong P, Rosolowski M, Scholz M, Willenberg A, Kratzsch J, et al. The novel cystatin C, lactate, interleukin-6, and N-terminal pro-B-type natriuretic peptide (CLIP)-based mortality risk score in cardiogenic shock after acute myocardial infarction. European heart journal. 2021;42(24):2344-52.
5. Kanwar MK, Everett KD, Gulati G, Brener MI, Kapur NK. Epidemiology and management of right ventricular-predominant heart failure and shock in the cardiac intensive care unit. European Heart Journal: Acute Cardiovascular Care. 2022;11(7):584-94.
6. Rittgerodt N, Pape T, Busch M, Becker LS, Schneider A, Wedemeyer H, et al. Predictors of response to intra-arterial vasodilatory therapy of non-occlusive mesenteric ischemia in patients with severe shock: results from a prospective observational study. Critical Care. 2022;26(1):92.
7. Sanchez EC, Pinsky MR, Sinha S, Mishra RC, Lopa AJ, Chatterjee R. Fluids and Early Vasopressors in the Management of Septic Shock: Do We Have the Right Answers Yet? The Journal of Critical Care Medicine. 2023;9(3):138-47.
8. Jentzer JC, Burstein B, Van Diepen S, Murphy J, Holmes Jr DR, Bell MR, et al. Defining shock and preshock for mortality risk stratification in cardiac intensive care unit patients. Circulation: Heart Failure. 2021;14(1):e007678.
9. Palitsky R, Da’Mere TW, Friedman SE, Ruiz JM, Sullivan D, O’Connor M-F. The relationship of prolonged grief disorder symptoms with hemodynamic response to grief recall among bereaved adults. Psychosomatic Medicine. 2023;85(6):545-50.
10. Bauer SR, Sacha GL, Lam SW, Wang L, Reddy AJ, Duggal A, et al. Hemodynamic response to vasopressin dosage of 0.03 units/min vs. 0.04 units/min in patients with septic shock. Journal of intensive care medicine. 2022;37(1):92-9.
11. SHAH P, SHAH A, DESAI R, AGRAWAL A. Assessing Reverse Shock Index as a Survival Predictor for Trauma Patients in Emergency Settings: A Retrospective Observational Study. Journal of Clinical & Diagnostic Research. 2024;18(5).
12. Bataille B, de Selle J, Moussot P-E, Marty P, Silva S, Cocquet P. Machine learning methods to improve bedside fluid responsiveness prediction in severe sepsis or septic shock: an observational study. British journal of anaesthesia. 2021;126(4):826-34.
13. Mathew R, Fernando SM, Hu K, Parlow S, Di Santo P, Brodie D, et al. Optimal perfusion targets in cardiogenic shock. JACC: Advances. 2022;1(2):100034.
14. Bauer SR, Sacha GL, Siuba MT, Lam SW, Reddy AJ, Duggal A, et al. Association of arterial pH with hemodynamic response to vasopressin in patients with septic shock: an observational cohort study. Critical Care Explorations. 2022;4(2):e0634.
15. Gupta CB, Basu D, Williams TK, Neff LP, Johnson MA, Patel NT, et al. Improving the precision of shock resuscitation by predicting fluid responsiveness with machine learning and arterial blood pressure waveform data. Scientific Reports. 2024;14(1):2227.
16. Sern Lim H. Cardiac power output index to define hemodynamic response to Impella support in cardiogenic shock. The International journal of artificial organs. 2022;45(7):598-603.
17. Bonanno FG. Management of Hemorrhagic Shock According to the Revised “Physiological Classification”-Update 2024. 2024.
18. Jentzer JC, Wiley BM, Anavekar NS, Pislaru SV, Mankad SV, Bennett CE, et al. Noninvasive hemodynamic assessment of shock severity and mortality risk prediction in the cardiac intensive care unit. Cardiovascular Imaging. 2021;14(2):321-32.
19. Fecher A, Stimpson A, Ferrigno L, Pohlman TH. The pathophysiology and management of hemorrhagic shock in the polytrauma patient. Journal of clinical medicine. 2021;10(20):4793.
20. Kashani K, Omer T, Shaw AD. The intensivist's perspective of shock, volume management, and hemodynamic monitoring. Clinical Journal of the American Society of Nephrology. 2022;17(5):706-16.
Article Sidebar
Published
Jan 30, 2025
Article Details
How to Cite
Dr. Muhammad Rahat Jan, Dr. Noman Hussain, Dr. Marifat Shah, Dr. Najma Fida, Dr. Muhammad Tariq, & Dr. Javaid Hassan. (2025). HEMODYNAMIC RESPONSES IN TRAUMA PATIENTS: A STUDY ON EARLY PHYSIOLOGIC AND PATHOLOGIC PREDICTOR OF SHOCK. Journal of Population Therapeutics and Clinical Pharmacology, 32(1), 665-673. https://doi.org/10.53555/2adp7955
Section
Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Author Biographies
Dr. Muhammad Rahat Jan
Trainee Medical Officer, Department of Emergency Medicine, Lady Reading Hospital, Peshawar, PakistanDr. Noman Hussain
Medical Officer, Department of Emergency Medicine, Lady Reading Hospital, Peshawar, PakistanDr. Marifat Shah
Associate Professor, Department of Medicine, Jinnah Medical College and Teaching Hospital, Peshawar, PakistanDr. Najma Fida
Assistant Professor, Department of Physiology, Kabir Medical College, Gandahara University, Peshawar, PakistanDr. Muhammad Tariq
Associate Professor, Department of Histopathology, Jinnah Medical College and Teaching Hospital, Peshawar, PakistanDr. Javaid Hassan
Assistant Professor, Kabir Medical College, Gandahara University, Peshawar, PakistanHow to Cite
Dr. Muhammad Rahat Jan, Dr. Noman Hussain, Dr. Marifat Shah, Dr. Najma Fida, Dr. Muhammad Tariq, & Dr. Javaid Hassan. (2025). HEMODYNAMIC RESPONSES IN TRAUMA PATIENTS: A STUDY ON EARLY PHYSIOLOGIC AND PATHOLOGIC PREDICTOR OF SHOCK. Journal of Population Therapeutics and Clinical Pharmacology, 32(1), 665-673. https://doi.org/10.53555/2adp7955