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Volatile anesthetic and outcome in acute trauma care: planned secondary analysis of the PROPPR study. Proc (Bayl Univ Med Cent) 2023;36(6):680-685

Date

10/13/2023

Pubmed ID

37829226

Pubmed Central ID

PMC10566423

DOI

10.1080/08998280.2023.2243204

Scopus ID

2-s2.0-85167820065 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

BACKGROUND: This retrospective analysis of prospectively collected data from the PROPPR study describes volatile anesthetic use in severely injured trauma patients undergoing anesthesia.

METHODS: After exclusions, 402 subjects were reviewed of the original 680, and 292 had complete data available for analysis. Anesthesia was not protocolized, so analysis was of contemporary practice.

RESULTS: The small group who received no volatile anesthetic (n = 25) had greater injury burden (Glasgow Coma Scale P = 0.05, Injury Severity Score P = 0.001, Revised Trauma Score P = 0.03), higher 6- and 24-hour mortality (P < 0.001), and higher incidence of systemic inflammatory response syndrome (P = 0.003) and ventilator-associated pneumonia (P = 0.02) than those receiving any volatile (n = 267). There were no differences in mortality between volatile agents at 6 hours (P = 0.51) or 24 hours (P = 0.35). The desflurane group was less severely injured than the isoflurane group. Mean minimum alveolar concentration was < 0.6 and lowest in the isoflurane group compared to the sevoflurane and desflurane groups (both P < 0.01). The incidence of systemic inflammatory response syndrome was lower in the desflurane group than in the isoflurane group (P = 0.007).

CONCLUSION: In this acutely injured trauma population, choice of volatile anesthetic did not appear to influence short-term mortality and morbidity. Subjects who received no volatile were more severely injured with greater mortality, representing hemodynamic compromise where volatile agent was limited until stable. As anesthetic was not protocolized, these findings that choice of specific volatile was not associated with short-term survival require prospective, randomized evaluation.

Author List

Livingston CE, Levy DT, Saroukhani S, Fox EE, Wade CE, Holcomb JB, Gumbert SD, Galvagno SM, Kaslow OY, Pittet JF, Pivalizza EP