Normalization of blood lactate as early end-point of polytrauma treatment

The main aim of the early treatment of polytrauma is recovery of patient's physiological functions. The early achievement of therapeutic goals, mainly adequate tissue perfusion and repayment of oxygen debt, are postulated. The aim of the study was to confirm whether blood lactate level as a quantifier of oxygen deficit, as well as normalization of blood lactate level within the first 24 hours, have an impact on the mortality and morbidity of seriously injured patients. Sixty-nine mechanically ventilated patients with a severe trauma and organ dysfunction defined according to SOFA score and ISS >17, age >15 years, were enrolled into this retrospective study. 8 patients died within first 24 hours, 8 patients did not reach serum lactate level above 2 mmol/l on admission to hospital. The hypothesis that normalization of serum lactate level within 24 hours is related to lower mortality and morbidity, was assessed. Reduced mortality and morbidity were represented by lower severity of multi-organ dysfunction, the highest SOFA score during hospitalization, lower incidence of sepsis, number of days in ICU and artificial ventilation. The association between severity of multi-organ failure (p=0.0006), mortality (p=0.0022) and repayment of oxygen debt was confirmed. Hypothesis of sepsis incidence was not confirmed (p=0.34). The association between number of days on artificial ventilation and number of days in ICU to repayment of oxygen debt was not confirmed either. Multivariate significant factors were age, GCS, ISS and SOFA score on patient's admission. The patients, who repaid oxygen debt within first 24 hours, have lower morbidity and mortality (Tab. 6, Ref. 19).