Accession Number:

ADA619028

Title:

Diagnostic and Predictive Values of Thirst, Angiotensin II, and Vasopressin During Trauma Resuscitation

Descriptive Note:

Journal article

Corporate Author:

ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX

Report Date:

2010-09-01

Pagination or Media Count:

8.0

Abstract:

Background. Thirst perception involves neurochemical signals attributed to acute elevation of arginine vasopressin AVP and angiotensin II AT2 levels, and may accompany acute hemorrhage. Objective. To determine whether thirst or plasma AVP or AT2 levels predict hemorrhagic shock, injury severity, or outcome in trauma patients at initial presentation. Methods. This was a prospective case series of adult subjects presenting as trauma activations to an urban level I trauma center. Subjects were included if they were alert and nonintoxicated. During resuscitation, subjects were queried for thirst perception using binary and continuous data formats employing a 100-mm nonhatched visual analog scale. Blood for AT2 and AVP assessment was obtained during initial laboratory collection. Other data were abstracted retrospectively from our trauma registry. Crude and stratified analyses blunt and penetrating trauma assessed the correlation of thirst, AVP, and AT2 to the initial shock index, base deficit, blood transfusion requirement, admission, and Injury Severity Score ISS. Our institutional review board IRB granted a waiver of informed consent. Results. Of 105 subjects, the average age was 35 years 95 confidence interval CI 32 to 38, with 31 penetrating trauma. For AVP, there was no difference in thirst perception between subjects with normal 59 mm, 95 CI 47 to 71 versus elevated 63 mm, 95 CI 56 to 70 plasma levels. For AT2, results were likewise insignificant for normal 63 mm, 95 CI 56 to 70 versus elevated 58 mm, 95 CI 46 to 70 plasma levels. Thirst, AT2 level, and AVP level demonstrated no correlation to shock index, base deficit, transfusion requirement, hospital admission, or ISS. Conclusion. The results of this study imply that thirst severity and AVP and AT2 plasma levels are not reliable predictors of impending hemorrhagic shock, injury severity, or outcome.

Subject Categories:

  • Biochemistry
  • Medicine and Medical Research
  • Pharmacology

Distribution Statement:

APPROVED FOR PUBLIC RELEASE