Abstract
Background:
Sepsis and Acute Respiratory Distress Syndrome (ARDS) are serious complications that contribute to high mortality and morbidity rate in polytrauma patients. Early resuscitation strategies like lactate clearance and organ dysfunction score (e.g. SOFA, APACHE II) have been widely used in the management of critically ill patients. However, their predictive value in the development of sepsis and ARDS in polytrauma patients remains unclear. This meta-analysis is aimed at assessing the role of these early resuscitation strategies, lactate clearance, organ dysfunction scores in predicting sepsis and ARDS in trauma patients.
Objectives:
This systematic review and meta-analysis aimed to evaluate and measure the predictive power of the early resuscitation policies, especially lactate clearance and ScvO2, in the formation of sepsis and ARDS among polytrauma patients. It further aimed to assess the clinical usefulness of organ dysfunction scores such as SOFA and APACHE II as predictors of adverse outcome such as sepsis and ARDS in these patients population. Additionally, the purpose of the review included synthesis of the data derived from observational studies to understand the risk factors and predictors of sepsis and ARDS in polytrauma patients, which can provide useful information in terms of early intervention of these complications.
Methods:
We conducted a systematic review and meta-analysis of both randomized controlled trials (RCTs) and observational studies. Articles were reviewed that were published between January 2000 and December 2023. The focus was on those that investigated early resuscitation strategies (lactate clearance, ScvO2), organ dysfunction scores (SOFA, APache II) and impact of sepsis and ARDS in trauma patients. Data on mortality, ICU length of stay (LOS), ventilation time and lactate clearance were extracted from 5 RCTs and 10 observational studies. Risk ratios (RR) for mortality and mean differences (MD) for ICU length of stay (LOS), ventilation time, and lactate clearance were combined using a random-effects model.
Results:
15 studies including 5 RCTs and 10 observational studies were included in the meta-analysis. Lactate clearance was associated with a significant decrease in mortality (RR = 0.70, 95% CI [0.54–0.91]), while no significant differences were found in ICU length of stay (MD = -0.45 days, 95% CI [-1.4, 0.5]) or ventilation time (MD = -1.2 hours, 95% CI [-3.4, 1.0]) between lactate-guided and ScvO2-guided resuscitation strategies. The scores of organ dysfunction (SOFA, APACHE II) were found to have a moderate association with mortality (MD = 1.3, 95% CI [0.5-21]) and ARDS progression in trauma patients. Observational support of lactate clearance and early resuscitation as significant predictors of lower sepsis and ARDS incidence in polytrauma patients.
Conclusion:
Lactate clearance and resuscitation strategies implemented early in the disease process and organ dysfunction scores are important predictors of sepsis and ARDS in polytrauma patients. Early intervention with these tools can help to improve clinical outcomes by reducing mortality and preventing complications such as ARDS. Further studies are required to improve thresholds for lactate clearance and assess their usefulness in protocols for trauma care with the goal of improving patient care.