Fluid ResuscitationFluid Resuscitation Optimization in Surgical Trauma Patients (FROST)

Inclusion Criteria:

1. 18 years of age or older
2. Injury Severity Score > 15 (indicator of anticipated trauma mortality)
3. Admission to Surgical-Trauma ICU (STICU)
4. Anticipated surgery within 72 hours of admission
5. American Society of Anesthesiology patient classification status (ASA) 2-5
6. Lactic acid > 2.5 within 24 hours of surgical procedure or Base deficit ≥ - 5 mmol/L, or persistent requirement for vasopressor support within 24 hours of surgical procedure
7. Patient requires mechanical ventilation prior to consenting surgery
8. Vascular devices that include a minimum of an arterial line
9. Minimally invasive hemodynamic monitoring initiated prior to first surgical procedure unless patient is taken emergently, e.g. OR from trauma bay
10. Patients requiring emergent initial operative procedures will be eligible for consenting if above criteria are met prior to their second surgical procedure
11. Anticipated operative procedure precipitating evaluation and/or consenting for study must be > 30 minutes in duration

• Procedures < 30 minutes would not result in significant metabolic stress necessitating a continuation of MIHM

Exclusion Criteria:

1. Pregnancy
2. Exclusions due to limitations with respect to accuracy of MIHM:

• Patients not intubated prior to surgical procedure
• Patients requiring an open thoracotomy
• Patients with known history of surgical intervention for peripheral vascular disease
• Patients with pre-existing atrial arrhythmias
• Patients who are on cardiopulmonary bypass

3. Isolated acute cerebral injury and/or traumatic cerebral injury

• Hemodynamic management in this patient population does not always follow typical/standard endpoints due to nuances of managing intracranial pressures

4. Cardiac arrest prior to enrollment
5. Patients with pre-existing, dialysis dependent, renal failure upon admission

• Hemodynamic management in this patient population does not always follow typical/standard endpoints due to nuances of managing renal failure

6. Patients with pre-existing cirrhosis

• Hepatic failure results in abnormal clearance of lactic acid

7. Patients with no survival injuries, e.g. gunshot wound to the head