Method and system for staged fluid resuscitation volume control in trauma hemorrhagic shock patients

Abstract

This invention belongs to the field of critical care technology, specifically relating to a phased fluid resuscitation volume control method and system for patients with traumatic hemorrhagic shock. The resuscitation process is divided into four core phases: initial resuscitation, optimized resuscitation, stable monitoring, and volume responsiveness assessment. Each phase has clearly defined physiological goals, monitoring parameters, and criteria for advancement or relapse. By dynamically and trend-based analyzing multiple vital signs and laboratory indicators, this invention provides clinicians with a complete and standardized decision-making path from aggressive resuscitation to stable withdrawal. This invention not only aims to effectively restore tissue perfusion but also focuses on minimizing the risk of complications such as rebleeding, coagulopathy, and heart failure caused by over-resuscitation or misjudgment, thus providing a safer and more reliable practical framework for improving the clinical prognosis of patients with traumatic hemorrhagic shock.

Description

Technical Field

[0001] This invention belongs to the field of critical care technology, specifically relating to a method and system for phased fluid resuscitation and volume regulation in patients with traumatic hemorrhagic shock. Background Technology

[0002] Traumatic hemorrhagic shock is a common critical illness in clinical practice. Its core pathophysiological link is the tissue insufficiency and hypoxia caused by a sharp decrease in effective circulating blood volume. Traditional fluid resuscitation strategies often emphasize early and rapid replenishment of large amounts of fluid to quickly raise blood pressure and restore circulatory stability. However, increasing clinical observations and studies have shown that this crude resuscitation approach, lacking precise control, can lead to a series of complications. For example, without effective control of the bleeding source, excessive increase in blood pressure may dislodge existing thrombi, exacerbating bleeding; while excessive infusion of crystalloid solutions can easily cause dilutional coagulopathy, hypothermia, and tissue edema, especially pulmonary edema and abdominal compartment syndrome, all of which can worsen the patient's condition and increase mortality.

[0003] While existing clinical guidelines recognize the aforementioned risks and have introduced concepts such as "damage-controlled resuscitation," they often lack a clear, coherent, multi-stage, and dynamically monitored, refined volume management process in practice. Many protocols only provide general goals and principles, failing to offer systematic, step-by-step specific steps and judgment criteria for crucial aspects such as how to smoothly transition from the initial resuscitation to the optimization phase, how to accurately determine whether volume status has truly been achieved, and how to determine whether continued fluid resuscitation is beneficial to the patient. This results in emergency clinical practice still relying heavily on the physician's personal experience, leading to significant differences in decision-making and inaccurate volume management.

[0004] Therefore, there is an urgent need in this field for a phased fluid resuscitation protocol that can be implemented throughout the entire treatment process for patients with traumatic hemorrhagic shock. This protocol should organically integrate bleeding control, volume resuscitation, organ perfusion assessment, and cardiac function assessment into a standardized process. It needs to abandon single, static indicators and instead rely on the dynamic and continuous trends of multiple hemodynamic and metabolic parameters to guide treatment decisions, thereby achieving individualized and refined control from emergency resuscitation to stable maintenance and then to withdrawal assessment. The ultimate goal is to restore effective perfusion while minimizing the risk of volume overload and related complications. Summary of the Invention

[0005] According to a first aspect of the present invention, the present invention claims protection for a method for phased fluid resuscitation and volume regulation in patients with traumatic hemorrhagic shock, comprising the following steps:

[0006] S1, In the initial resuscitation phase, crystalloid fluid is infused into the patient to be controlled, and the mean arterial pressure and heart rate of the patient to be controlled are continuously monitored. When the mean arterial pressure rises to a first predetermined threshold and the heart rate drops to a second predetermined threshold, the initial resuscitation phase is determined to end and the optimized resuscitation phase is entered.

[0007] S2, during the optimized resuscitation phase, the infusion rate is slowed down and switched to colloid infusion. At the same time, the central venous pressure and urine output of the patient to be controlled are monitored. By adjusting the infusion rate of the colloid, the central venous pressure is maintained within a specific pressure range and the urine output is maintained within a specific flow range. After a predetermined stabilization time, the stabilization monitoring phase begins.

[0008] S3, during the stable monitoring phase, active fluid infusion is paused, and the vital signs parameters of the patient to be controlled are monitored. If the mean arterial pressure and central venous pressure of the patient to be controlled remain stable within the predetermined observation period, the volume responsiveness assessment phase is entered. If a downward trend is observed, the patient returns to the optimized resuscitation phase.

[0009] S4, During the volume responsiveness assessment phase, a passive leg raise test is performed on the patient, while continuously monitoring changes in the patient's heart rate and mean arterial pressure. If, after the passive leg raise test, the increase in mean arterial pressure exceeds a predetermined value and the decrease in heart rate exceeds another predetermined value, the patient is determined to have volume responsiveness, and the patient returns to the optimized resuscitation phase for supplemental fluid infusion. If the changes do not reach the predetermined values, the patient is determined to have no volume responsiveness, the current fluid balance is maintained, and the current fluid resuscitation intervention ends.

[0010] Furthermore, in step S1, the patient's arterial blood lactate level is monitored simultaneously while the crystalloid solution is being infused.

[0011] The initial resuscitation phase is considered complete when the mean arterial pressure and heart rate reach the first and second predetermined thresholds, and the arterial blood lactate level begins to show a downward trend.

[0012] Furthermore, in step S2, while monitoring central venous pressure and urine output, the dynamic changes in arterial blood lactate levels are continuously tracked.

[0013] During the optimized resuscitation phase, while ensuring that central venous pressure and urine output reach the specified ranges, arterial blood lactate levels continue to decrease to below a safe threshold.

[0014] Furthermore, in step S3, the vital signs parameters that are closely monitored also include arterial blood lactate levels;

[0015] Criteria for determining that vital signs remain stable also include that arterial blood lactate levels do not rise during the predetermined observation period.

[0016] Furthermore, in step S4, if it is determined that the patient has no volume responsiveness, then the cardiac function assessment step is further initiated.

[0017] The patient's myocardial contractility is assessed through clinical examination. If weakened myocardial contractility is found, cardiotonic drugs are used for treatment intervention.

[0018] Furthermore, prior to step S1, a pre-control step is included: a rapid assessment of whether the patient has active bleeding; if active bleeding is confirmed, definitive hemostasis measures are immediately taken while performing fluid resuscitation; the definitive hemostasis measures include surgical intervention or interventional embolization.

[0019] Further, in step S2, the colloidal solution is a hydroxyethyl starch solution or a gelatin solution;

[0020] The specific method for adjusting the infusion rate of the colloid solution is to accelerate the infusion when the central venous pressure is below the lower limit of the specific pressure range, and slow down or stop the infusion when it approaches or reaches the upper limit.

[0021] Furthermore, in steps S3 and S4, the patient's body temperature is monitored and maintained simultaneously. The patient's core body temperature is maintained within the normal physiological range by using a warming infusion device and a warming blanket to avoid hypothermia affecting the accuracy of hemodynamic parameters and coagulation function.

[0022] Furthermore, the method also includes continuous bleeding and coagulation monitoring steps throughout the entire execution process:

[0023] Regularly check the patient's hemoglobin concentration and coagulation function indicators;

[0024] If a progressive decrease in hemoglobin concentration or coagulation dysfunction occurs during fluid resuscitation, an early warning signal will be issued, indicating that there may be undetected persistent bleeding or coagulation dysfunction, requiring reassessment and intervention.

[0025] In step S4, the operating standard for the passive leg-raising test is as follows:

[0026] The patient was changed from a supine position to a position with both legs raised at a predetermined angle, and this position was maintained for a predetermined time. Throughout the process, an ultrasound probe placed on the patient's body surface was used to monitor changes in femoral vein blood flow velocity, and the increase in blood flow velocity was used as an additional indicator to help determine volume responsiveness.

[0027] According to a second aspect of the present invention, the present invention claims protection for a phased fluid resuscitation volume regulation system for patients with traumatic hemorrhagic shock, comprising:

[0028] One or more processors;

[0029] A memory having stored one or more programs that, when executed by one or more processors, enable the one or more processors to implement the described method for phased fluid resuscitation volume regulation in patients with traumatic hemorrhagic shock.

[0030] This invention belongs to the field of critical care technology, specifically relating to a phased fluid resuscitation volume control method and system for patients with traumatic hemorrhagic shock. The resuscitation process is divided into four core phases: initial resuscitation, optimized resuscitation, stable monitoring, and volume responsiveness assessment. Each phase has clearly defined physiological goals, monitoring parameters, and criteria for advancement or relapse. By dynamically and trend-based analyzing multiple vital signs and laboratory indicators, this invention provides clinicians with a complete and standardized decision-making path from aggressive resuscitation to stable withdrawal. This invention not only aims to effectively restore tissue perfusion but also focuses on minimizing the risk of complications such as rebleeding, coagulopathy, and heart failure caused by over-resuscitation or misjudgment, thus providing a safer and more reliable practical framework for improving the clinical prognosis of patients with traumatic hemorrhagic shock. Attached Figure Description

[0031] Figure 1 This is a flowchart illustrating a phased fluid resuscitation volume control method for patients with traumatic hemorrhagic shock, for which the present invention is claimed.

[0032] Figure 2 This is a structural diagram of a phased fluid resuscitation volume control system for patients with traumatic hemorrhagic shock, for which protection is claimed in this invention. Detailed Implementation

[0033] The technical solutions of the embodiments of this application will be clearly and completely described below with reference to the accompanying drawings. Obviously, the described embodiments are only a part of the embodiments of this application, and not all of the embodiments. Based on the embodiments of this application, all other embodiments obtained by those of ordinary skill in the art without creative effort are within the scope of protection of this application.

[0034] In this document, the term "embodiment" means that a particular feature, structure, or characteristic described in connection with an embodiment may be included in at least one embodiment of this application. The appearance of this phrase in various places throughout the specification does not necessarily refer to the same embodiment, nor is it a mutually exclusive, independent, or alternative embodiment. It will be explicitly and implicitly understood by those skilled in the art that the embodiments described herein can be combined with other embodiments.

[0035] According to a first embodiment of the present invention, the present invention claims protection for a method for phased fluid resuscitation and volume regulation in patients with traumatic hemorrhagic shock, referring to... Figure 1This includes the following steps:

[0036] S1, In the initial resuscitation phase, crystalloid fluid is infused into the patient to be controlled, and the mean arterial pressure and heart rate of the patient to be controlled are continuously monitored. When the mean arterial pressure rises to a first predetermined threshold and the heart rate drops to a second predetermined threshold, the initial resuscitation phase is determined to end and the optimized resuscitation phase is entered.

[0037] S2, during the optimized resuscitation phase, the infusion rate is slowed down and switched to colloid infusion. At the same time, the central venous pressure and urine output of the patient to be controlled are monitored. By adjusting the infusion rate of the colloid, the central venous pressure is maintained within a specific pressure range and the urine output is maintained within a specific flow range. After a predetermined stabilization time, the stabilization monitoring phase begins.

[0038] S3, during the stable monitoring phase, active fluid infusion is paused, and the vital signs parameters of the patient to be controlled are monitored. If the mean arterial pressure and central venous pressure of the patient to be controlled remain stable within the predetermined observation period, the volume responsiveness assessment phase is entered. If a downward trend is observed, the patient returns to the optimized resuscitation phase.

[0039] S4, During the volume responsiveness assessment phase, a passive leg raise test is performed on the patient, while continuously monitoring changes in the patient's heart rate and mean arterial pressure. If, after the passive leg raise test, the increase in mean arterial pressure exceeds a predetermined value and the decrease in heart rate exceeds another predetermined value, the patient is determined to have volume responsiveness, and the patient returns to the optimized resuscitation phase for supplemental fluid infusion. If the changes do not reach the predetermined values, the patient is determined to have no volume responsiveness, the current fluid balance is maintained, and the current fluid resuscitation intervention ends.

[0040] In this embodiment, during the initial resuscitation phase, at least one large-diameter intravenous access is established for rapid infusion of room-temperature crystalloid solution. During this process, the patient's mean arterial pressure is continuously monitored using a non-invasive blood pressure monitor, and the patient's heart rate is continuously monitored using an electrocardiogram monitor. When the mean arterial pressure is detected to rise to a pre-set target pressure threshold level, and the heart rate is simultaneously detected to drop to a pre-set target heart rate threshold level, it is determined that the goal of the initial resuscitation phase has been achieved, and the optimized resuscitation phase is immediately initiated.

[0041] During the optimized resuscitation phase, the crystalloid infusion rate is reduced and switched to colloid infusion. During this phase, a central venous catheter is inserted to monitor central venous pressure, and a urinary catheter is placed to monitor urine output per unit time. The colloid infusion rate is adjusted manually or via an infusion pump. The specific adjustment logic is as follows: when the central venous pressure reading is below a preset lower limit of the pressure range, the infusion rate is increased; when the central venous pressure reading approaches or reaches the upper limit of that pressure range, the infusion is reduced or paused. Simultaneously, urine output per unit time is maintained within a preset flow rate range. Once the central venous pressure and urine output remain within the above target range for a preset minimum time period, the stabilization monitoring phase begins.

[0042] During the stable monitoring phase, all active fluid infusions are discontinued, but intravenous access remains open. During this phase, mean arterial pressure (MAP) and central venous pressure (CVP) values ​​continue to be monitored and recorded at fixed time intervals. A pre-set observation period is observed. If no clinically significant downward trend is observed in multiple measurements of MAP and CVP within this observation period, the volume responsiveness assessment phase begins. If either parameter shows a sustained decrease below its respective target threshold, this phase is terminated, and the patient returns to the optimized resuscitation phase to resume fluid infusion.

[0043] During the volume responsiveness assessment phase, the patient is changed from a supine position to a position with legs elevated and maintained in this position for a predetermined period of time. Before, during, and after the position change, the patient's heart rate and mean arterial pressure are continuously monitored. If, during or after the leg elevation, the increase in mean arterial pressure exceeds a predetermined threshold and the decrease in heart rate exceeds another predetermined threshold, the patient's volume responsiveness is considered positive, indicating the need for continued volume supplementation, and the patient returns to the optimized resuscitation phase. If the changes in the above parameters do not reach the predetermined thresholds, the volume responsiveness is considered negative, the current state is maintained, and the current fluid resuscitation control procedure is terminated.

[0044] Furthermore, in step S1, the patient's arterial blood lactate level is monitored simultaneously while the crystalloid solution is being infused.

[0045] The initial resuscitation phase is considered complete when the mean arterial pressure and heart rate reach the first and second predetermined thresholds, and the arterial blood lactate level begins to show a downward trend.

[0046] In this embodiment, during the initial resuscitation phase, while infusing crystalloid solution, the patient's arterial blood lactate level is periodically measured using an arterial blood gas analyzer. The criteria for determining the end of the initial resuscitation phase are increased to: mean arterial pressure and heart rate reaching their respective target thresholds, and the latest measured arterial blood lactate level showing a clear downward trend compared to the baseline value measured for the first time before resuscitation.

[0047] Furthermore, in step S2, while monitoring central venous pressure and urine output, the dynamic changes in arterial blood lactate levels are continuously tracked.

[0048] During the optimized resuscitation phase, while ensuring that central venous pressure and urine output reach the specified ranges, arterial blood lactate levels continue to decrease to below a safe threshold.

[0049] In this embodiment, during the optimized resuscitation phase, while regulating central venous pressure and urine output, arterial blood lactate levels are continuously measured at fixed time intervals using arterial blood gas analysis. The objectives of this phase further include ensuring that, while central venous pressure and urine output are stable within target ranges, the arterial blood lactate levels measured in two consecutive measurements are both below a preset safety threshold before entering the stable monitoring phase.

[0050] Furthermore, in step S3, the vital signs parameters that are closely monitored also include arterial blood lactate levels;

[0051] Criteria for determining that vital signs remain stable also include that arterial blood lactate levels do not rise during the predetermined observation period.

[0052] In this embodiment, during the stable monitoring phase, the vital signs parameters to be monitored also include arterial blood lactate levels; the criteria for determining that vital signs remain stable are increased to: during the predetermined observation period, mean arterial pressure and central venous pressure remain stable, and the arterial blood lactate levels measured during this period show no upward trend.

[0053] Furthermore, in step S4, if it is determined that the patient has no volume responsiveness, then the cardiac function assessment step is further initiated.

[0054] The patient's myocardial contractility is assessed through clinical examination. If weakened myocardial contractility is found, cardiotonic drugs are used for treatment intervention.

[0055] In this embodiment, during the volume responsiveness assessment phase, if the patient's volume responsiveness is determined to be negative, a cardiac function assessment sub-process is then initiated. This sub-process includes assessing jugular venous distension through physical examination, auscultating the lungs for moist rales, and visually assessing ventricular wall motion using a portable ultrasound device to comprehensively determine myocardial contractility. If the assessment concludes that myocardial contractility is weakened, cardiotonic drugs are administered intravenously according to the predetermined medication regimen, and the hemodynamic status is reassessed without increasing fluid infusion.

[0056] Furthermore, prior to step S1, a pre-control step is included: a rapid assessment of whether the patient has active bleeding; if active bleeding is confirmed, definitive hemostasis measures are immediately taken while performing fluid resuscitation; the definitive hemostasis measures include surgical intervention or interventional embolization.

[0057] In this embodiment, before starting the initial resuscitation phase, a pre-assessment and control step is performed: physical examination is conducted to check for active bleeding points on the body surface, and imaging examination is conducted to determine for occult bleeding within the body cavity; once an active bleeding source is confirmed, the surgical team is immediately coordinated to perform surgical hemostasis or the interventional radiology team is coordinated to perform endovascular embolization hemostasis while fluid resuscitation is initiated; the goal of fluid resuscitation in this case is adjusted to maintain an acceptable minimum perfusion level before hemostasis measures are completed.

[0058] Further, in step S2, the colloidal solution is a hydroxyethyl starch solution or a gelatin solution;

[0059] The specific method for adjusting the infusion rate of the colloid solution is to accelerate the infusion when the central venous pressure is below the lower limit of the specific pressure range, and slow down or stop the infusion when it approaches or reaches the upper limit.

[0060] In this embodiment, during the optimized resuscitation phase, the selected colloidal solution is either hydroxyethyl starch solution or succinyl gelatin solution. The specific operation method for adjusting the colloidal solution infusion rate is as follows: the nursing staff manually rotates the infusion set pulley to adjust the drip rate based on the real-time monitoring value of the central venous pressure, or sets a new rate parameter on the infusion pump to achieve fine control of the central venous pressure.

[0061] Furthermore, in steps S3 and S4, the patient's body temperature is monitored and maintained simultaneously. The patient's core body temperature is maintained within the normal physiological range by using a warming infusion device and a warming blanket to avoid hypothermia affecting the accuracy of hemodynamic parameters and coagulation function.

[0062] In this embodiment, during the stability monitoring phase and the volume responsiveness assessment phase, body temperature maintenance measures are implemented simultaneously: all infused fluids are preheated to near the core body temperature using a fluid warmer, and the patient is covered with an actively inflatable warming blanket; the core temperature is continuously monitored using a temperature sensor attached to the skin, and the body temperature is maintained within a narrow range of normal physiological fluctuations through the above measures to ensure that the measurement of hemodynamic parameters is not affected by hypothermia.

[0063] Furthermore, the method also includes continuous bleeding and coagulation monitoring steps throughout the entire execution process:

[0064] Regularly check the patient's hemoglobin concentration and coagulation function indicators;

[0065] If a progressive decrease in hemoglobin concentration or coagulation dysfunction occurs during fluid resuscitation, an early warning signal will be issued, indicating that there may be undetected persistent bleeding or coagulation dysfunction, requiring reassessment and intervention.

[0066] In step S4, the operating standard for the passive leg-raising test is as follows:

[0067] The patient was changed from a supine position to a position with both legs raised at a predetermined angle, and this position was maintained for a predetermined time. Throughout the process, an ultrasound probe placed on the patient's body surface was used to monitor changes in femoral vein blood flow velocity, and the increase in blood flow velocity was used as an additional indicator to help determine volume responsiveness.

[0068] In this embodiment, from the initial resuscitation phase to the end of the process, a parallel bleeding and coagulation monitoring loop is executed: venous blood samples are drawn from the patient at fixed time intervals and sent to the laboratory for analysis of hemoglobin concentration, prothrombin time, and activated partial thromboplastin time; if a progressive decrease in hemoglobin concentration or a significant prolongation of coagulation time is detected, an alert is triggered, prompting the clinical team to immediately reassess the patient's bleeding status and coagulation function, and prepare appropriate blood products for transfusion;

[0069] During the passive leg raise test in the volume responsiveness assessment phase, an auxiliary monitoring method was added: a blood flow probe of a portable Doppler ultrasound device was fixed at the patient's femoral vein surface projection position to continuously monitor the blood flow spectrum of the femoral vein; changes in peak blood flow velocity were recorded before and after the change in body position; the percentage increase in peak blood flow velocity was used as an auxiliary indicator, combined with changes in heart rate and mean arterial pressure, to jointly determine the patient's volume responsiveness in the final comprehensive assessment.

[0070] According to a second embodiment of the present invention, referring to Figure 2 This invention claims protection for a phased fluid resuscitation volume control system for patients with traumatic hemorrhagic shock, comprising:

[0071] One or more processors;

[0072] A memory having stored one or more programs that, when executed by one or more processors, enable the one or more processors to implement the described method for phased fluid resuscitation volume regulation in patients with traumatic hemorrhagic shock.

[0073] The following is a specific example:

[0074] Patient placement and initial assessment: The patient was moved to the resuscitation unit of the intensive care unit and immediately placed in a supine position without a pillow. The attending physician quickly conducted an initial assessment, including checking the level of consciousness, airway patency, and skin and mucous membrane color, to confirm the typical signs of tissue hypoperfusion. At the same time, a nurse quickly prepared the necessary equipment and fluids.

[0075] For the specific procedure of establishing intravenous access, select the median cubital vein or basilic vein of the upper limb as the puncture point. If the peripheral vascular conditions are not good, prepare immediately for puncture of the internal jugular vein or femoral vein or other central veins. After skin disinfection, use a large-bore indwelling intravenous needle for puncture. After seeing smooth blood return, fix the needle handle and connect the pre-prepared infusion tubing with a flow regulating valve. To ensure rapid infusion, consider establishing two or more intravenous accesses at the same time.

[0076] Fluid infusion and initial monitoring are initiated by suspending a room-temperature crystalloid bag on the IV stand and fully opening the flow control valve to allow the fluid to infuse at maximum gravity speed. Simultaneously, another nurse attaches a non-invasive blood pressure cuff to the patient's unaffected upper limb and sets the monitoring mode to high-frequency interval measurement. Electrodes of the electrocardiogram monitor are accurately placed on the corresponding positions on the patient's chest, continuously displaying the electrocardiogram waveform and calculating the heart rate. All monitoring data are displayed in real time on the central monitoring screen.

[0077] In the process of determining whether the target has been achieved, the attending physician closely monitors the monitor screen to observe the dynamic trends of mean arterial pressure and heart rate. When the mean arterial pressure curve starts to rise steadily from a low level and eventually reaches the preset target pressure threshold, and the heart rate value continues to drop from a high level to the preset target heart rate threshold, the physician will ask the nurse to report the three most recent measurements to confirm the stability of the trend. After confirming that both have been achieved and the trend is stable, the physician gives the verbal instruction: "Initial resuscitation target achieved, stop rapid infusion, prepare to enter the optimized resuscitation phase."

[0078] During the optimized resuscitation phase, the nurses quickly replaced the infused crystalloid solution with a colloid solution and significantly reduced the infusion rate from a high speed to a gentle maintenance rate. Simultaneously, under strict aseptic conditions, the physician inserted a central venous catheter, connected to a pressure sensor at the end of the catheter. After zeroing, the central venous pressure waveform and value were continuously displayed. Another nurse disinfected the patient's urethra and inserted a sterile urinary catheter, which was connected to a urine bag with metering markings, to begin recording hourly urine output.

[0079] The meticulous management of volume control involves bedside nurses receiving clear instructions to closely monitor central venous pressure readings. If the reading remains below the lower limit of the target range, the infusion set pulley is slowly rotated clockwise to appropriately increase the drip rate, while closely monitoring pressure changes. If the reading rises to near or reach the upper limit of the target range, the pulley is immediately rotated counterclockwise to reduce the drip rate, or even the tubing is temporarily shut off to observe whether the pressure drops. Simultaneously, urine output is recorded at the end of each hour to ensure it remains between the preset minimum and maximum flow rates. Throughout the process, nurses are required to regularly report vital signs and fluid balance to the physician.

[0080] The confirmation of the phase progression is that when the central venous pressure and urine output remain within the target range for a preset continuous period of time, and there is no need to frequently adjust the infusion rate during this period, the physician assesses that the volume status has reached an optimal balance, and then instructs the patient to enter the stable monitoring phase.

[0081] During the stable monitoring phase, in addition to maintaining patency of the intravenous access, no fluids are actively infused to expand the volume; the monitor continues to record the mean arterial pressure and central venous pressure at fixed time intervals; the nurse marks the values ​​of each measurement on a specially made process record sheet on time and connects them to form a trend graph.

[0082] Stability assessment and decision-making: Physicians periodically review trend charts within a pre-defined observation period. The focus is on assessing whether parameters show a sustained, clinically significant decline; for example, whether mean arterial pressure shows a continuous downward trend over several consecutive measurement cycles, rather than just minor fluctuations around a certain value. If the trend is completely stable, the plan is to proceed to the next phase. If a clear decline occurs, it is determined that volume has not yet stabilized, and the optimized resuscitation phase colloid infusion protocol is immediately restarted.

[0083] Details of the passive leg raise test during the volume responsiveness assessment phase: After briefly explaining the purpose of the procedure to the patient or family, two medical staff work together; one person stands at the foot of the patient's bed, supporting the patient's heels and calves with both hands, while the other person supports the patient's thighs and buttocks. With consistent commands, the patient's lower limbs are smoothly raised to the designated angle, and the position is maintained with soft padding; throughout the process, the patient's torso remains in contact with the bed surface, and only the position of the lower limbs changes.

[0084] To capture and interpret hemodynamic responses, a set of baseline heart rate and mean arterial pressure values ​​were recorded before leg raising. During the leg raising period and after lowering the leg, the physician closely monitored the changes in these two parameters on the monitor screen. The focus was on observing whether, after leg raising, there was a rapid increase in mean arterial pressure exceeding a preset threshold, and whether there was a corresponding decrease in heart rate exceeding another threshold. This positive response was considered a sign that increased cardiac preload led to increased cardiac output, indicating that the patient could still benefit from further fluid resuscitation. If no such change was observed, it indicated that cardiac function was in a plateau phase, and continued fluid resuscitation would be ineffective.

[0085] Lactate monitoring is added during the initial resuscitation phase. While rapidly infusing crystalloid solutions during this phase, nurses periodically draw blood samples from the patient's arterial or venous blood (if an arterial line has been established) and immediately send them to a blood gas analyzer for testing. The arterial blood lactate level is highlighted in the test report.

[0086] While assessing whether the mean arterial pressure and heart rate are within the target range, the physician will compare the current lactate level with the baseline value before resuscitation.

[0087] Only when lactate levels show a clear and continuous downward trend (e.g., the second measurement is lower than the first) can the initial recovery phase goals be definitively confirmed. This avoids the possibility that persistent tissue hypoxia might be masked by recovery based solely on stress indicators.

[0088] In the optimized resuscitation phase, lactate targets are increased. In addition to regulating central venous pressure and urine output, nurses will still draw blood samples at fixed intervals (such as every half hour or one hour) to monitor arterial blood lactate.

[0089] The goals of this stage become three-dimensional: central venous pressure stabilizes within the target range, urine output meets the target, and arterial blood lactate levels measured twice consecutively drop below the preset safety threshold. Only when these three conditions are met simultaneously and maintained for the required minimum time period can the stable monitoring phase begin.

[0090] This ensures that while optimizing capacity, the oxygen debt of cells is also fundamentally corrected.

[0091] Lactate monitoring was added during the stable monitoring phase. During the observation period of the stable monitoring phase, monitoring of arterial blood lactate continued.

[0092] The criteria for determining "stability" have become more stringent, requiring not only that the mean arterial pressure and central venous pressure show no significant downward trend, but also that the arterial blood lactate level measured during this period remains stable or continues to decline slowly, with absolutely no meaningful rebound.

[0093] If lactate levels rise, even if blood pressure and central venous pressure are temporarily stable, it is considered an early warning sign of deteriorating tissue perfusion, requiring immediate return to the optimized resuscitation phase for intervention.

[0094] After a negative volume responsiveness test, cardiac function assessment is added. The procedure does not end immediately when the passive leg raise test shows a negative volume responsiveness.

[0095] The physician will then initiate a systematic cardiac function assessment sub-process, starting with a physical examination:

[0096] Slowly raise the head of the patient's bed and observe for jugular vein distension in the neck; carefully auscultate the bases of both lungs with a stethoscope to check for moist rales (indicating pulmonary edema); then, use a portable ultrasound device to place the probe in the precordial region to quickly assess the range of motion and coordination of the walls of each ventricle.

[0097] If a generalized decrease in ventricular wall motion or segmental motion abnormalities are found, combined with jugular venous distension or pulmonary rales, the primary diagnosis is impaired myocardial contractility. In this case, the treatment focus shifts to cardiotonics rather than volume expansion, meaning that cardiotonics are administered intravenously according to the pre-determined medication regimen, and hemodynamic parameters are monitored again.

[0098] Increasing pre-treatment bleeding control steps: After contacting the patient and initially determining that they are in traumatic hemorrhagic shock, the medical team will prioritize a rapid but comprehensive bleeding source identification procedure before any fluid resuscitation begins.

[0099] This includes: carefully examining the entire body surface for any visible active bleeding wounds, and focusing on palpation and visual inspection of all blunt or penetrating wound areas. At the same time, immediately use bedside ultrasound to perform a focused abdominal trauma assessment (FAST scan) to explore the abdominal cavity, pericardial cavity, etc. for any free fluid (blood accumulation).

[0100] Once a clear or highly suspected active bleeding source is identified, the resuscitation strategy is immediately adjusted. While rapidly establishing intravenous access, the highest priority becomes urgently contacting the surgical or interventional team for hemostasis (such as surgery or vascular embolization).

[0101] At this point, the goal of fluid resuscitation is set as "damage control resuscitation," which means infusing only a small amount of fluid to maintain the mean arterial pressure at a minimum level that ensures basic perfusion of vital organs, avoiding the dislodgement of existing thrombi due to excessively rapid increases in blood pressure, which could worsen bleeding.

[0102] The type of colloidal solution and the adjustment method are clearly defined. In the optimized recovery phase, the selected colloidal solution is specifically specified as two commonly used types:

[0103] Hydroxyethyl starch solution or succinyl gelatin solution, and choose one according to the hospital pharmacy's routine drug preparation.

[0104] Regarding the adjustment of the infusion rate, two common clinical methods are used:

[0105] One method is for nurses to manually rotate the pulley on the infusion set to control the drip rate based on the central venous pressure reading, and estimate the flow rate by visually observing the speed of the droplets in the drip chamber. Another, more precise method is to use a smart infusion pump, where nurses can preset the target range of central venous pressure into the pump, or input a new milliliters per hour rate parameter directly into the pump according to the doctor's instructions, and the pump will automatically and accurately execute the command.

[0106] Increased body temperature maintenance measures were implemented, given that hypothermia can severely affect coagulation function and drug metabolism in patients with shock. From the stabilization monitoring phase to the volume responsiveness assessment phase, proactive body temperature maintenance measures were carried out simultaneously.

[0107] All fluids prepared for infusion (including drug carriers that may be used later) must be preheated using a dedicated fluid warmer to bring their temperature close to the body's core temperature.

[0108] At the same time, the patient is covered with an active inflatable warming blanket, and the warm air inside the blanket circulates on the patient's skin.

[0109] A body temperature sensor is attached to the patient's skin (such as under the armpit or on the forehead) to continuously monitor the body surface temperature as a reference for the core temperature;

[0110] These comprehensive measures aim to maintain the patient's body temperature within a narrow normal physiological range, ensuring that the monitored hemodynamic parameters truly reflect the volume status, rather than being a false impression caused by hypothermia.

[0111] Add a bleeding and coagulation monitoring loop, a monitoring loop that runs parallel to and throughout the above four stages;

[0112] From the initial resuscitation phase, nurses will draw venous blood samples from patients at fixed intervals (such as every hour), attach clear labels, and rush them to the laboratory.

[0113] Key laboratory indicators include hemoglobin concentration (reflecting whether there is progressive bleeding leading to blood dilution) and prothrombin time and activated partial thromboplastin time (reflecting whether there is a coagulation disorder).

[0114] These results will be promptly reported to the attending physician. If a progressive decrease in hemoglobin concentration or a significantly prolonged clotting time exceeding the normal range is detected, an alert will be triggered immediately. Based on this, the physician will conduct a comprehensive reassessment of the patient's bleeding status and coagulation function, and prepare appropriate blood products (such as red blood cell suspension, fresh frozen plasma, etc.) in advance for component transfusions to correct coagulation disorders at any time.

[0115] The passive leg raising test is enhanced with Doppler ultrasound monitoring, adding an objective auxiliary monitoring method to the standard passive leg raising test.

[0116] A trained physician or ultrasound technician applies a coupling gel to the blood flow probe of a portable Doppler ultrasound machine and places it stably on the surface projection of the femoral artery in the patient's groin area (Note: The femoral vein mentioned in the claims is usually located deeper and has a weaker signal; in clinical practice, the femoral artery is more often monitored as an alternative).

[0117] After the probe is fixed, the blood flow spectrum waveform is continuously displayed on the screen. Before the leg is raised, a baseline peak blood flow velocity is recorded. During the leg raising period, the peak velocity is recorded again. The percentage increase of the peak velocity after leg raising relative to the baseline value is calculated. This percentage change is used as an auxiliary, quantitative indicator. Finally, the physician combines the decrease in heart rate, the increase in mean arterial pressure, and the percentage increase in the peak femoral artery blood flow velocity for comprehensive judgment, thereby more accurately determining the patient's volume responsiveness and reducing misjudgments that may be caused by a single indicator.

[0118] In the several embodiments provided in this application, it should be understood that the disclosed systems, apparatuses, and methods can be implemented in other ways. For example, the apparatus embodiments described above are merely illustrative; for instance, the division of units is only a logical functional division, and in actual implementation, there may be other division methods. For example, multiple units or components may be combined or integrated into another system, or some features may be ignored or not executed. Furthermore, the coupling or direct coupling or communication connection shown or discussed may be through some interfaces, or indirect coupling or communication connection between apparatuses or units, and may be electrical, mechanical, or other forms.

[0119] Furthermore, the functional units in the various embodiments of this application can be integrated into one processing unit, or each unit can exist physically separately, or two or more units can be integrated into one unit. The integrated units described above can be implemented in hardware or as software functional units. The above are merely embodiments of this application and do not limit the patent scope of this application. Any equivalent structural or procedural transformations made based on the description and drawings of this application, or direct or indirect applications in other related technical fields, are similarly included within the patent protection scope of this application.

[0120] The specific embodiments of the invention have been described in detail above, but they are only examples, and this application is not limited to the specific embodiments described above. For those skilled in the art, any equivalent modifications or substitutions to the invention are also within the scope of this application. Therefore, all equivalent changes, modifications, and improvements made without departing from the spirit and principles of this application should be covered within the scope of this application.

Claims

1. A phased fluid resuscitation volume regulation system for patients with traumatic hemorrhagic shock, characterized in that, include: One or more processors; A memory having stored one or more programs that, when executed by one or more processors, enable the one or more processors to implement a phased fluid resuscitation volume control method for patients with traumatic hemorrhagic shock. The method includes the following steps: S1, In the initial resuscitation phase, crystalloid fluid is infused into the patient to be controlled, and the mean arterial pressure and heart rate of the patient to be controlled are continuously monitored. When the mean arterial pressure rises to a first predetermined threshold and the heart rate drops to a second predetermined threshold, the initial resuscitation phase is determined to end and the optimized resuscitation phase is entered. S2, during the optimized resuscitation phase, the infusion rate is slowed down and switched to colloid infusion. At the same time, the central venous pressure and urine output of the patient to be controlled are monitored. By adjusting the infusion rate of the colloid, the central venous pressure is maintained within a specific pressure range and the urine output is maintained within a specific flow range. After a predetermined stabilization time, the stabilization monitoring phase begins. S3, during the stable monitoring phase, active fluid infusion is paused, and the vital signs parameters of the patient to be controlled are monitored. If the mean arterial pressure and central venous pressure of the patient to be controlled remain stable within the predetermined observation period, the volume responsiveness assessment phase is entered. If a downward trend is observed, the patient returns to the optimized resuscitation phase. S4, During the volume responsiveness assessment phase, a passive leg raise test is performed on the patient, while continuously monitoring changes in the patient's heart rate and mean arterial pressure. If, after the passive leg raise test, the increase in mean arterial pressure exceeds a predetermined value and the decrease in heart rate exceeds another predetermined value, the patient is determined to have volume responsiveness, and the patient returns to the optimized resuscitation phase for supplemental fluid infusion. If the changes do not reach the predetermined values, the patient is determined to have no volume responsiveness, the current fluid balance is maintained, and the current fluid resuscitation intervention ends.

2. The staged fluid resuscitation volume regulation system for patients with traumatic hemorrhagic shock according to claim 1, characterized in that, In step S1, the patient's arterial blood lactate level is monitored simultaneously while the crystalloid solution is being infused. The initial resuscitation phase is considered complete when the mean arterial pressure and heart rate reach the first and second predetermined thresholds, and the arterial blood lactate level begins to show a downward trend.

3. The staged fluid resuscitation volume regulation system for patients with traumatic hemorrhagic shock according to claim 2, characterized in that, In step S2, while monitoring central venous pressure and urine output, the dynamic changes in arterial blood lactate levels are also continuously tracked. During the optimized resuscitation phase, while central venous pressure and urine output reach specific ranges, it is essential to ensure that arterial blood lactate levels continue to decrease below a safe threshold.

4. The staged fluid resuscitation volume regulation system for patients with traumatic hemorrhagic shock according to claim 3, characterized in that, In step S3, the vital signs parameters that are closely monitored also include arterial blood lactate levels; Criteria for determining that vital signs remain stable also include that arterial blood lactate levels do not rise during the predetermined observation period.

5. A staged fluid resuscitation volume control system for patients with traumatic hemorrhagic shock according to claim 1, characterized in that, In step S4, if it is determined that the patient has no volume responsiveness, then the cardiac function assessment step is further initiated. The patient's myocardial contractility is assessed through clinical examination. If weakened myocardial contractility is found, cardiotonic drugs are used for treatment intervention.

6. The staged fluid resuscitation volume regulation system for patients with traumatic hemorrhagic shock according to claim 1, characterized in that, Prior to step S1, a pre-control step is included: a rapid assessment of whether the patient has active bleeding; if active bleeding is confirmed, definitive hemostasis is immediately implemented while fluid resuscitation is being performed; the definitive hemostasis includes surgical intervention or interventional embolization.

7. A staged fluid resuscitation volume control system for patients with traumatic hemorrhagic shock according to claim 1, characterized in that, In step S2, the colloidal solution is a hydroxyethyl starch solution or a gelatin solution; The specific method for adjusting the infusion rate of the colloid solution is to accelerate the infusion when the central venous pressure is below the lower limit of the specific pressure range, and slow down or stop the infusion when it approaches or reaches the upper limit.

8. The staged fluid resuscitation volume control system for patients with traumatic hemorrhagic shock according to claim 1, characterized in that, In steps S3 and S4, the patient's body temperature is monitored and maintained simultaneously. The patient's core body temperature is kept within the normal physiological range by using a warming infusion device and a warming blanket to avoid hypothermia affecting the accuracy of hemodynamic parameters and coagulation function.

9. A staged fluid resuscitation volume control system for patients with traumatic hemorrhagic shock according to claim 1, characterized in that, The method also includes continuous bleeding and coagulation monitoring throughout the entire process: Regularly check the patient's hemoglobin concentration and coagulation function indicators; If a progressive decrease in hemoglobin concentration or coagulation dysfunction occurs during fluid resuscitation, an early warning signal will be issued, indicating that there may be undetected persistent bleeding or coagulation dysfunction, requiring reassessment and intervention. In step S4, the operating standard for the passive leg-raising test is as follows: The patient was changed from a supine position to a position with both legs raised at a predetermined angle, and this position was maintained for a predetermined time. Throughout the process, an ultrasound probe placed on the patient's body surface was used to monitor changes in femoral vein blood flow velocity, and the increase in blood flow velocity was used as an additional indicator to help determine volume responsiveness.

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