Early goal-directed therapy on prognosis in traumatic shock patients: Acute traumatic splenic rupture

Traumatic shock is one of the leading causes of death in trauma patients, particularly prominent in patients with acute traumatic splenic rupture. Early Goal-Directed Therapy (EGDT), as a comprehensive rescue strategy, has achieved good results in septic shock, but its application value in traumatic shock, especially in patients with splenic rupture, needs further validation. This study aims to evaluate the impact of the EGDT protocol on the prognosis of traumatic shock patients with acute traumatic splenic rupture. 92 patients with acute traumatic splenic rupture complicated by traumatic shock admitted to our institution between January 2021 and December 2023 were retrospectively reviewed. Patients were categorized into a conventional treatment group (n=40) and an EGDT group (n=52) based on the treatment approach documented in their medical records. The control group received conventional trauma treatment, while the EGDT group implemented early goal-directed therapy on the basis of conventional treatment, including fluid resuscitation, hemodynamic monitoring, optimization of oxygen supply-demand balance parameters, and setting specific treatment goals: central venous pressure 8-12mmHg, mean arterial pressure ≥65mmHg, central venous oxygen saturation ≥70%, lactate clearance rate ≥10%/h. Primary outcome measures included 28-day mortality, ICU length of stay, mechanical ventilation duration, shock reversal time, and the incidence of multiple organ dysfunction syndrome (MODS). The 28-day mortality rate in the EGDT group was significantly lower than in the control group (11.7% vs 26.7%, P<0.05); The EGDT group had significantly shorter ICU length of stay (6.2±2.1 vs 9.5±3.4 days, P<0.01), mechanical ventilation duration (3.5±1.4 vs 5.8±2.2 days, P<0.01), and shock reversal time (18.2±5.6 vs 27.3±8.4 hours, P<0.01) compared to the control group; The incidence of MODS in the EGDT group was significantly lower than in the control group (15.0% vs 31.7%, P<0.05). Multivariate analysis showed that EGDT was an independent protective factor for improving the prognosis of traumatic shock patients with acute traumatic splenic rupture (OR=0.42, 95%CI: 0.24-0.73, P<0.01). Early goal-directed therapy can significantly improve the prognosis of traumatic shock patients with acute traumatic splenic rupture, reduce mortality and complication rates, shorten ICU length of stay and mechanical ventilation duration, and is an effective rescue strategy for such patients.