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Minute-to-minute urine flow rate variability: a retrospective survey of its ability to provide early warning of acute hypotension in critically ill multiple trauma patients

  • Evgeni BrotfainEmail author
  • Yoram Klein
  • Ronen Toledano
  • Micha Yitzhak Shamir
  • Leonid Koyfman
  • Uri Barak
  • Tamar Guttmann
  • Alexander Zlotnik
  • Moti Klein
Original Article

Abstract

Purpose

Dynamic changes in urine output and neurological status are the recognized clinical signs of hemodynamically significant hemorrhage. In the present study, we analyzed the dynamic minute-to-minute changes in the UFR and also the changes in its minute-to-minute variability in a group of critically ill multiple trauma patients whose blood pressures were normal on admission to the ICU but who subsequently developed hypotension within the first few hours of their ICU admission.

Patients and methods

The study was retrospective and observational. Demographic and clinical data were extracted from the computerized register information systems initially; the clinical and laboratory data of 100 critically ill patients with multiple trauma who were admitted to the ICU during the study period were analyzed. Of this group, ten patients were eventually included in the study on the basis of the inclusion criteria.

Results

The minute-to-minute urine flow rate (UFR) and urine flow rate variability (UFRV) both decreased significantly during the periods of hypotension (p values 0.001 and 0.006, respectively). Notably, the decrease in UFRV preceded by at least 30 min a corresponding decline in the systolic and mean arterial blood pressures, which manifested as a flattening of UFRV amplitude which was observed prior to the occurrence of the lowest recorded systolic and mean arterial blood pressures. Statistical analysis by the Pearson method demonstrated a strong direct correlation between the decrease in UFRV and the decrease in the MAP (R = 0.9, p = 0.001), and SBP (R = 0.86, p = 0.001) and the decreasing urine output per hour (R = 0.88, p < 0.001).

Conclusion

We found that changes in UFRV correlate strongly with systolic and mean arterial blood pressures. We feel that this parameter could potentially serve as an early signal of hemodynamic deterioration due to occult bleeding in critically ill trauma patients, and might also be able to identify the optimal end-point of hemodynamic resuscitative measures in these patients.

Keywords

Minute-to-minute urine flow rate variability Hypovolemia Cardiovascular instability Hemorrhagic shock Multiple trauma 

Notes

Author contributions

EB—participated in study design, data collection, data analysis, data interpretation. YK—participated in literature search, study design, data collection, data analysis, data interpretation. RT—participated in data collection, performed the statistical analysis, data interpretation. MYS—participated in the sequence alignment and drafted the manuscript. LK—participated in the design of the study, performed the statistical analysis and helped to revise the manuscript. UB—participated in the design of the study, performed the statistical analysis and helped to revise the manuscript. TG—participated in the design of the study, performed the statistical analysis and helped to revise the manuscript. AZ—participated in the design of the study, performed the statistical analysis and helped to revise the manuscript. MK—participated in the design of the study, coordination and helped to draft the manuscript. All authors read and approved the manuscript. The manuscript has not been submitted to more than one journal for simultaneous consideration.

Funding

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval

The Human Research and Ethics Committee at Soroka Medical Center, Beer Sheva, Israel, approved this study (RN- SOR-0158-14). The patients’ concern has not been needed because of retrospective nature of the study.

Informed consent

Consent to submit has been received explicitly from all co-authors.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Evgeni Brotfain
    • 2
    Email author
  • Yoram Klein
    • 1
  • Ronen Toledano
    • 3
  • Micha Yitzhak Shamir
    • 4
  • Leonid Koyfman
    • 2
  • Uri Barak
    • 5
  • Tamar Guttmann
    • 2
  • Alexander Zlotnik
    • 2
  • Moti Klein
    • 2
  1. 1.Division of TraumaSheba Medical CenterRamat GanIsrael
  2. 2.General Intensive Care Unit, Department of Anesthesiology and Critical Care, Soroka Medical CenterBen-Gurion University of the NegevBeershebaIsrael
  3. 3.Clinical Research Center, Soroka Medical CenterBen-Gurion University of the NegevBeershebaIsrael
  4. 4.General Intensive Care Unit, Department of Anesthesiology and Critical CareHadassah Medical CenterJerusalemIsrael
  5. 5.Department of Orthopedic SurgeryRabin Medical CenterPetah TikvaIsrael

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