Volaemic resuscitation in critical patients with severe haemorrhagic shock. Complications due to impaired microvascular system and ischaemia/reperfusion syndrome: A Case Report

摘要

Severe trauma is one of the most common causes of death all around the world. Complications of haemorrhagic shock, such as coagulopathy, hypothermia and metabolic acidosis, form the lethal triad in trauma.In this case report we present a male patient admitted with severe haemorrhagic shock – haemoglobin (Hb) 5.6 mg/dL, arterial pressure (AP) 60/53 mmHg, heart beat (HB) 140 bpm, hypothermia (35 0C), lactic acidosis pH 7.21, lactates (Lac) 3.9 mmol/L, excess bases BE(E) – 12.8 mmol/L.Volume resuscitation was started in the emergency department (ED), and continued in the operating room (OR). Fluid resuscitation was guided taking into account a number of factors, such as maintaining fluid and electrolyte balance, protecting the microcirculation, avoidance of ischaemia / reperfusion syndrome, minimization and inhibition of free radical synthesis, responsible for oxidative stress, by administration of high doses of antioxidants.During Intensive Care Unit (ICU) admission, the patient developed severe left lower limb ischaemia. After clinical and laboratory investigations, it was decided to perform a femoral-popliteal by-pass. Failure of the by-pass resulted in amputation of the left lower limb. The patient was discharged from ICU after 27 days of intensive therapy and nursing.In conclusion, we can affirm that the adjustment of fluid management, as well as administration of substances with antioxidant properties, improved the clinical status of the patient and chance of survival.