ANOVA-Based Analysis of Early Blood Transfusions on Hemodynamics with Severely Injured Trauma Using Bedside Ultrasound Imaging - Hindawi.com
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Hindawi
Journal of Healthcare Engineering
Volume 2021, Article ID 5263454, 6 pages
https://doi.org/10.1155/2021/5263454
Research Article
ANOVA-Based Analysis of Early Blood Transfusions on
Hemodynamics with Severely Injured Trauma Using Bedside
Ultrasound Imaging
Lei Song , Jianguo Zhang , and Junliang Liu
Department of Intensive Care Unit, The Affiliated Qingdao Hospital of Shandong First Medical University, Qingdao 266109,
Shandong, China
Correspondence should be addressed to Junliang Liu; 2201800164@neepu.edu.cn
Received 2 June 2021; Accepted 14 July 2021; Published 22 July 2021
Academic Editor: Enas Abdulhay
Copyright © 2021 Lei Song et al. This is an open access article distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The focus of the study was to quantitatively analyze the influence of early massive blood transfusions (MBTs) on the hemo-
dynamics and prognostic living quality of patients with severely injured trauma. 114 patients with severely injured trauma were
enrolled into MBT group (67 cases) and nonmassive blood transfusions (NBT) group (47 cases) according to whether they
accepted MBTs within 24 hours after the admission. All patients had bedside ultrasound technology scanning. Furthermore, the
indexes were calculated for inferior vena cava (IVC), peripheral arteries, and heart. The prognostic deaths were recorded. It was
found that, in the MBT group, the mortality was lower (7.55% vs. 24.23%) (P < 0.05), and these indexes were higher for the IVC
expansion (IVCE), the respiration variation index (RVI) of IVC (ΔIVC2), the peak flow velocity RVI of brachial artery
(ΔVpeakBA), femoral artery (ΔVpeakFA), left ventricular outflow tract (ΔVpeakL), and aorta (ΔVpeakAO), as well as peak flow
velocity time integral RVI of aorta (ΔVTIAO) (P < 0.05). In conclusion, early MBTs can elevate survival rate and prognostic living
quality and alleviate the atrophy degree of IVC, peripheral artery, and blood vessel of patients with severely injured trauma.
Furthermore, bedside ultrasound scanning demonstrated superb capabilities in quantitatively displaying hemodynamics and
outcomes of MBTs of patients with severely injured trauma.
1. Introduction Clinical observations have revealed that, in addition to
bleeding caused by liver and spleen lacerations and fractures,
Trauma refers to the destruction of tissues or organs caused the abnormal coagulation function of patients is also a very
by mechanical factors. Due to the differences in injured key factor for continuous bleeding [5, 6]. At present, the
parts, injured tissues, and skin integrity, the severity of clinical treatment methods of bleeding in patients with
trauma is also different [1, 2]. Among them, severely injured severely injured trauma mainly contain permissive hypo-
trauma may cause systemic reactions, with local manifes- tension, hemostasis, and resuscitation. Patients with heavy
tations such as pain, swelling, tenderness in the injured area, bleeding need timely blood transfusion therapy to correct
and even fatal symptoms such as hemorrhage, shock, suf- coagulation disorders and improve the prognosis of trauma
focation, and disturbance of consciousness [3]. Relevant patients. Therefore, the primary objective of the study was to
studies have reported that trauma has become the leading explore the influence of massive transfusions on patients
cause of death for people under the age of 40, even exceeding with severely injured trauma.
the total number of deaths from AIDS, tuberculosis, and With the advancement of imaging, there are various
malaria [4]. Furthermore, the people who die from trauma imaging examination methods used in clinical practice.
every year are mostly teenagers, which greatly affect social However, being time-consuming, the routine imaging scan
stability and economic development. Traumatic bleeding has is not suitable for the diagnosis of trauma and bleeding
always been the main cause of death in trauma patients. patients, such as ultrasound, conventional CT, X-ray, and2 Journal of Healthcare Engineering
angiography [7]. Plain X-ray is the earliest imaging method and great vessel split; (v) patients with incomplete clinical
used. It features simple operation and low price, but the data; and (vi) patients with head trauma.
display of soft tissue is poor, and it is prone to misdiagnosis
and missed diagnosis [8, 9]. Angiography can be used to
observe the blood flow in the arteries or veins of the head, 2.2. Grouping of Subjects. 114 patients with severely injured
arms, legs, chest, back, or abdomen, but it is easily affected by trauma were enrolled into MBT group (67 cases) and NBT
body movements. Although conventional CT is easy to group (47 cases) according to whether they accepted MBTs
operate, it cannot show minor damage [10]. As a result, within 24 hours after the admission. The standard of massive
bedside ultrasound has been a hotspot in clinical research in blood transfusions no less than 20 U red blood cells were
recent years. It is usually used in emergency and life- injected within 24 hours after admission.
threatening conditions to speed up diagnosis and treatment
[11]. Because bedside real-time ultrasound performs a single
2.3. Bedside Ultrasound Scanning. Patients accepted bedside
or local examination for a specific clinical phenotype, it
ultrasound scanning before and after treatment by Sono
greatly shortens the examination time and can quickly
ultrasonic machine (USA). A 2.5 MHz heart probe was used.
provide crucial information, such as the patient’s systolic,
The patient was in a supine position. The long axis of the left
diastolic function, volume load, heart structure, and he-
heart next to the sternum was selected, that is, the long axis
modynamics. Balı́k [12] adopted transcranial Doppler ul-
of the left ventricle. The heart probe was placed between 3
trasound to monitor the cerebral blood flow of severely
and 4 intercostals of the left edge of the sternum. The de-
injured trauma patients. The results showed that ultrasound
tection direction was parallel to the right sternoclavicular
images can accurately diagnose the hemodynamics and
joint to center the transverse section of the thoracic aorta.
position the blood vessels before intubation to avoid po-
The probe was slightly upward on the basis of the four-
tential complications and unnecessary platelet transfusion.
chamber heart at the apex of the heart, and the scanning
Gomora-Garcı́a et al. [13] used ultrasound to guide the
plane passed through the aortic root to obtain the transverse
treatment of patients with painful shoulder trauma syn-
section of the aortic root, the longitudinal section of the left
drome. The results found that ultrasound-guided treatment
ventricle, the longitudinal section of the right atrium, the
demonstrated better effects in contrast with conventional
longitudinal section of the right ventricle, and the longi-
treatment and was safer. Therefore, the further aim was to
tudinal section of the right atrium, namely, the image of the
apply bedside ultrasound to analyze the diagnostic results of
five-chamber heart at the apex. IVCE, ΔIVC2, ΔVpeakBA,
severely injured trauma.
ΔVpeakFA, ΔVpeakL, ΔVpeakAO, and ΔVTIAO were recor-
In summary, bedside ultrasound demonstrated superb
ded. IVCE refers to the difference between the maximum
capabilities in clinical diagnosis and treatment of severely
diameter (IVCmax ) and the minimum diameter (IVCmin ) of
injured trauma patients. Based on this, 114 patients with
IVC at 2 cm of the opening of right atrium which was then
severely injured trauma were enrolled into MBT group (67
divided by IVCmin . The equation is as follows:
cases) and NBT group (47 cases) according to whether they
accepted MBTs within 24 hours after the admission. All IVCmax − IVCmin
IVCE � × 100%. (1)
patients had bedside ultrasound technology scanning. IVCmin
Furthermore, the indexes were calculated for IVC, periph-
eral arteries, and heart, to quantitatively analyze the influ-
ence of early MBTs on the hemodynamics and prognostic 2.4. Statistics. The data were processed by SPSS19.0. The
living quality of patients with severely injured trauma. mean ± standard deviation (x ± s) illustrated how to calcu-
late the measurement data. Count data were expressed as a
2. Materials and Methods percentage (%). Age, BMI, length of hospital stays, male-
female ratio, and mortality were compared using inde-
2.1. Selection of Samples. 114 patients with severely injured pendent t-test. The analysis of variance was applied to
trauma, who were admitted to the hospital between No- compare indexes for IVC, peripheral arteries, and heart.
vember 25, 2017, and February 10, 2020, were selected for P < 0.05 indicated statistically significant differences.
analysis, with an average age between 20 and 67. All of them
had bedside ultrasound scanning. The study has been ap- 3. Results
proved by the Medical Ethics Committee of the hospital. The
patient and his/her family members have been informed of 3.1. Comparison of Basic Data. Figures 1 and 2 show the
the study and signed the consent letters. comparison of basic data of patients. In the MBT group, the
Inclusion criteria: (i) patients older than 18 years; (ii) patients were 43.51 ± 9.73 years old, their BMIs were
patients who underwent bedside ultrasound within 12 hours 24.76 ± 4.79 m2/kg, the ratio of males was 68.56%, and the
after trauma; (iii) patients with an abbreviated injury scale length of hospital stay was 33.51 ± 7.53 days. In the NBT
(AIS) score greater than 3; (iv) patients who can cooperate group, the patients were 41.73 ± 11.24 years old, their BMIs
with the doctors. were 26.11 ± 5.22 m2/kg, the proportion of males was
Exclusion criteria: (i) patients with unstable hemody- 64.37%, and the length of hospital stay was 31.75 ± 8.22 days.
namics; (ii) patients with congenital heart disease; (iii) pa- There was no notable difference in age, BMI, the ratio of
tients with severe kidney disease; (iv) patients with aortic males, and the length of hospital stays (P > 0.05).Journal of Healthcare Engineering 3
60
50
40
30
20
10
0
MBT NMT
Age (years old)
BMI (kg/m2)
Figure 1: Comparison of the age and the BMI.
Figure 3: The ultrasound image of a male (aged 34) with traumatic
80 renal laceration caused by a car accident.
70
60
50
40
30
20
10
0
MBT NMT
Hospitalization time (day)
Male (%)
Figure 2: Comparison of the hospitalization time and the male
ratio.
Figure 3 shows traumatic kidney injury in a male patient
(aged 34 years old) caused by a car accident. It was evident
that the lower part of the right kidney was morphologically Figure 4: The ultrasound image of a female (aged 26) with
traumatic renal parenchymal laceration caused by a car accident.
abnormal, there was a heterogeneous echogenic mass, and
an acoustic image of a clot can be seen in the bladder.
Figure 4 shows traumatic renal parenchymal laceration 3.5. Comparison of ΔVpeakAO and ΔVTIAO. Figure 8 pre-
caused by a car accident in a female (aged 26 years old). The sented the comparison of ΔVpeakAO and ΔVTIAO. It was
renal parenchymal laceration with hematoma was visible, evident that, in the MBT group, ΔVpeakAO (15.77 ± 1.48 vs.
the renal capsule was intact, and a hypoechoic mass was seen 12.75 ± 1.51) and ΔVTIAO (18.88 ± 1.62 vs. 13.47 ± 1.36) were
in the middle parenchyma with a clear boundary. obviously higher (P < 0.05).
3.2. Comparison of Mortality. Figure 5 shows the compar- 3.6. Comparison of ΔVpeakBA and ΔVpeakFA. Figure 9 shows
ison of mortality of the two groups. It was evident that, in the the comparison of ΔVpeakBA and ΔVpeakFA. It was evident
MBT group, the mortality was lower (7.55% vs. 24.23%) that, in the MBT group, ΔVpeakBA (21.55 ± 1.42 vs.
(P < 0.05). 14.92 ± 1.36) and ΔVpeakFA (17.53 ± 1.38 vs. 13.66 ± 1.51)
were obviously higher (P < 0.05).
3.3. Comparison of IVCE and IVC2. Figure 6 shows the 4. Discussion
comparison of IVCE and IVC2. It was evident that, in the
MBT group, IVCE (21.54 ± 4.11 vs. 13.52 ± 3.27) and IVC2 Patients with severely injured trauma should see a doctor in
(13.52 ± 3.27 vs. 13.17 ± 2.86) were obviously higher time to determine the degree of trauma as quickly as pos-
(P < 0.05). sible, so as to provide targeted clinical treatment. Although
the domestic diagnostic technology has been greatly im-
proved in recent years, the shock and mortality caused by
3.4. Comparison of ΔVpeakL. Figure 7 shows the comparison severely injured trauma are still high, so it is very important
of ΔVpeakL. It was evident that, in the MBT group, ΔVpeakL to adopt effective diagnostic methods [14, 15]. In the study,
was obviously higher (19.56 ± 2.76 vs. 14.11 ± 1.85) bedside ultrasound scanning was applied to patients to
(P < 0.05). analyze the influence of early MBTs on hemodynamics and4 Journal of Healthcare Engineering
NMT ∗
MBT
0 5 10 15 20 25
Mortality rate (%)
∗
Figure 5: Comparison of mortality. Note. indicates that there was a notable difference in contrast with the MBT group (P < 0.05).
30
25
20
∗ ∗
15
10
5
0
MBT NMT
IVCE
IVC2
Figure 6: Comparison of IVCE and RVI. Note. ∗ indicates that there was a notable difference in contrast with the MBT group (P < 0.05).
NMT ∗
MBT
0 5 10 15 20 25
ΔVpeakL
∗
Figure 7: Comparison of ΔVpeakL. Note. indicated that there was a notable difference in contrast with MBT group (P < 0.05).
25
20
15 ∗ ∗
10
5
0
MBT NMT
ΔVpeakAO
ΔVTIAO
∗
Figure 8: Comparison of ΔVpeakAO and ΔVTIAO. Note. indicates that there was a notable difference in contrast with the MBT group
(P < 0.05).Journal of Healthcare Engineering 5
25
20
∗
15 ∗
10
5
0
MBT NMT
ΔVpeakBA
ΔVpeakFA
Figure 9: Comparison of ΔVpeakBA and ΔVpeakFA. Note. ∗ indicates that there was a notable difference in contrast with the MBT group
(P < 0.05).
prognostic living quality of them. It was found that, in the effectively promote the recovery of the blood flow of the
MBT group, the mortality was lower (7.55% vs. 24.23%) peripheral arteries, expand the peripheral arteries, and even
(P < 0.05). This was in line with the research results of Nolte make them return to normal.
et al. [16]. Existing research believes that early MBTs for
severely injured trauma can actively improve the coagulation 5. Conclusion
disorder after acute trauma, thereby enhancing the prog-
nosis of trauma patients. It suggested that early MBTs can In the study, 114 patients with severely injured trauma were
elevate survival rate and prognostic quality of patients and enrolled into MBT group (67 cases) and NBT group (47
reduce shock death. In the MBT group, IVCE (21.54 ± 4.11 cases) according to whether they accepted MBTs within 24
vs. 13.52 ± 3.27) and IVC2 (13.52 ± 3.27 vs. 13.17 ± 2.86) were hours after the admission. They all had bedside ultrasound
obviously higher (P < 0.05). This was inconsistent with the scanning. The results revealed that early MBTs can elevate
research results of Cui and Wu [17]. IVC is the main blood survival rate and prognostic living quality and alleviate the
vessel that returns blood to the abdominal organs and lower atrophy degree of IVC, peripheral artery, and blood vessel of
limbs. In the early stage of trauma, the internal diameter is patients with severely injured trauma. Furthermore, bedside
reduced due to the reduction of blood flow back to the lower ultrasound scanning demonstrated superb capabilities in
limbs and abdomen. However, early MBTs can effectively quantitatively displaying hemodynamics and outcomes of
compensate for the ischemic state of patients with severely MBTs of patients with severely injured trauma. However,
injured trauma and improve IVCE and IVC2. some limitations should be noted in the study. The sample
In the MBT group, ΔVpeakL was obviously higher size is relatively small, which may reduce the power and
(19.56 ± 2.76 vs. 14.11 ± 1.85) (P < 0.05). This was different increase the margin of error of the study. A study with an
from the research results of Endo et al. [18], which may be expanded sample size is necessary to strengthen the findings.
because of the different sample sources. It demonstrated that In summary, the results obtained provide a theoretical basis
MBTs allow the patient to receive enough blood to restore for the application of bedside ultrasound scanning in di-
normal blood flow. In the MBT group, ΔVpeakAO agnosis of patients with severely injured trauma.
(15.77 ± 1.48 vs. 12.75 ± 1.51) and ΔVTIAO (18.88 ± 1.62 vs.
13.47 ± 1.36) were obviously higher (P < 0.05). This illus-
trated that the early MBTs greatly affected the abdominal
Data Availability
aortic vessels, which may be due to the fact that the ab- No data were used to support this study.
dominal aortic vessels mainly regulate blood flow through
changes in tube diameter and distal resistance and will
supplement the overall capacity of human body by reducing Conflicts of Interest
its own blood flow when there is trauma [19]. In the MBT The authors declare that they have no conflicts of interest.
group, ΔVpeakBA (21.55 ± 1.42 vs. 14.92 ± 1.36) and
ΔVpeakFA (17.53 ± 1.38 vs. 13.66 ± 1.51) were obviously
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