Aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients: an analysis of the Glue Grant database.
Aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients: an analysis of the Glue Grant database.
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DOI：
10.1097/ta.0b013e3182826e13
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发表时间：
2013-05
期刊：
影响因子：
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通讯作者：
Inflammation and Host Response to Injury Investigators
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文献类型：
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作者：
Kasotakis G;Sideris A;Yang Y;de Moya M;Alam H;King DR;Tompkins R;Velmahos G;Inflammation and Host Response to Injury Investigators
有证据表明，在各种临床情况下，积极的晶体复苏与显著的发病率相关。我们想评估积极的早期晶体复苏是否会对成人钝性创伤患者的预后产生不利影响。数据来源于Glue Grant数据库。我们的主要结局指标是全因住院死亡率。次要结局包括机械通气天数；重症监护病房（ICU）和住院时间（LOS）；炎症（急性肺损伤和呼吸窘迫综合征[ALI/ARDS]，多器官衰竭[MOF]）和复苏相关的发病率（腹部和四肢间室综合征，急性肾功能衰竭）和医院感染（呼吸机相关性肺炎[VAP]，血流[BSI]，尿路[UTI]和手术部位感染[SSI]）。在我们的1754例患者样本中，住院死亡率不受影响，但呼吸机天数（p<0.001）、ICU （p=0.009）和医院（p=0.002） LOS与损伤后最初24小时内注入晶体药物的量密切相关。当控制年龄、格拉斯哥昏迷量表（GCS）损伤严重程度和急性生理紊乱、合并症以及胶体和血液制品输注时，晶体复苏的量也与ARDS （p<0.001）、MOF （p<0.001）、血流（p=0.001）和SSI （p<0.001）以及腹部（p<0.001）和肢体间室综合征（p=0.028）的发生呈剂量依赖关系。晶体复苏与成人钝性创伤患者的发病率以及ICU和医院LOS的大幅增加有关。2 b
Evidence suggests that aggressive crystalloid resuscitation is associated with significant morbidity in various clinical settings. We wanted to assess whether aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients. Data were derived from the Glue Grant database. Our primary outcome measure was all-cause in-hospital mortality. Secondary outcomes included days on mechanical ventilation; intensive care unit (ICU) and hospital length of stay (LOS); inflammatory - (acute lung injury and respiratory distress syndrome [ALI/ARDS], multiple organ failure [MOF]) and resuscitation-related morbidity (abdominal and extremity compartment syndromes, acute renal failure) and nosocomial infections (ventilator associated pneumonia [VAP], bloodstream [BSI], urinary tract [UTI] and surgical site infections [SSI]). In our sample of 1,754 patients, in-hospital mortality was not affected, but ventilator days (p<0.001), as well as ICU (p=0.009) and hospital (p=0.002) LOS correlated strongly with the amount of crystalloids infused in the first 24 hours post-injury. Amount of crystalloid resuscitation was also associated with development of ARDS (p<0.001), MOF (p<0.001), bloodstream (p=0.001) and SSI (p<0.001), as well as abdominal (p<0.001) and extremity compartment syndromes (p=0.028) in a dose-dependent fashion, when age, Glasgow Coma Scale (GCS) severity of injury and acute physiologic derangement, comorbidities, and colloid & blood product transfusions were controlled for. Crystalloid resuscitation is associated with a substantial increase in morbidity, as well as ICU and hospital LOS in adult blunt trauma patients. 2b