Evaluation of the effect on morbidity and mortality of the application of a protocol in cases of major bleeding in Hospital Universitario Hernando Moncaleano, Neiva

Abstract

Introduction. Major bleeding is common in the operating room and is the cause of 40% of trauma deaths. Diagnosis and appropriate treatment from anaesthesiologists are crucial for survival. Hospital Universitario, Neiva, holds no data about morbidity and mortality in this particular scenario, nor is there a standardised protocol to follow if major bleeding occurs. Objective. Determine morbidity and mortality in 24 hours and mortality in 30 days in patients over the age of 15 years diagnosed with major bleeding in the operating room, implementing a standard protocol.  Equipment and Methods. A quasi-experimental study for patients with major bleeding was designed. For the prospective cohort, standard protocol was implemented. The serum lactate level, base excess and mortality in 24 hours and 30 days were recorded and then compared with the historic cohort taken from the records of the Intensive Care Unit. Results. Of 63 patients, 26 (41.9%) were controlled without the need for protocol, 13 (21.1%) received the complete protocol and an incomplete protocol was implemented in 24 (38%) cases. Where the protocol was implemented, the projected mortality in 24 hours fell from 48/1000 to 32/1000. In 30 days, the mortality rate was 129/1000 where the protocol was not implemented, 48/1000 where an incomplete protocol was implemented and 32/1000 where the complete protocol was implemented. When the protocol was applied, the serum lactate level reduced and the base excess increased. Conclusions. Applying the protocol in patients with major bleeding reduces mortality in 24 hours and 30 days after the triggering event by 70%.