Physiologic parameters:
(1) body temperature and hypothermia
(2) pH
(3) base deficit
Findings in body temperature associated with poor outcome:
(1) initial temperature in OR < 34°C
(2) fall in temperature during laparotomy
(3) final temperature in OR < 35°C
where:
• Handling the fall in temperature is difficult. In the discussion in page 1036 the temperature of nonsurvivors fell < 35°C, which would trigger the third finding. In addition, the parameters to judge a falling temperature are not specified.
• In survivors the body temperature increased by the time surgery was complete.
Findings in pH values:
(1) initial pH < 7.0
(2) persistent pH approximating 7.2 during laparotomy for abdominal vascular injury
Base deficit:
(1) initial base deficit approximating –20
(2) persistent base deficit approximating –10 in the operating room
The presence of 2 or more of these findings should prompt:
(1) discontinuation of a laparotomy once hemorrhage has been controlled
(2) complex surgical repairs should be deferred
(3) taking steps to reverse the abnormal physiologic finding
