Decreasing maintenance fluids in normotensive trauma patients may reduce intensive care unit stay and ventilator days

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• 作者：Galinos Barmparas ; MD ^{Galinos.Barmparas@cshs.org" class="auth_mail" title="E-mail the corresponding author} ; Ara Ko ; MD ^{Ara.Ko@cshs.org" class="auth_mail" title="E-mail the corresponding author} ; Megan Y. Harada ; BA ^{Megan.Harada@cshs.org" class="auth_mail" title="E-mail the corresponding author} ; Andrea A. Zaw ; MD ^{Andrea.zaw@cshs.org" class="auth_mail" title="E-mail the corresponding author} ; Jason S. Murry ; MD ^{Jason.murry@cshs.org" class="auth_mail" title="E-mail the corresponding author} ; Eric J.T. Smith ; BA ^{e.73.smith@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Sogol Ashrafian ; BS ^{Sogol.ashrafian@cshs.org" class="auth_mail" title="E-mail the corresponding author} ; Beatrice J. Sun ; BS ^{Beatrice.sun@cshs.org" class="auth_mail" title="E-mail the corresponding author} ; Eric J. Ley ; MD ; ^{Eric.ley@cshs.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Fluid resuscitation ; To keep open ; Normotensive ; Maintenance fluid rate ; Fluid balance
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：31
• 期：1
• 页码：201-205
• 全文大小：275 K

文摘

The purpose of the study is to determine if excessive fluid administration is associated with a prolonged hospital course and worse outcomes.

Materials and methods

In July 2013, all normotensive trauma patients admitted to the surgical intensive care unit (ICU) were administered crystalloids at 30 mL/h (“to keep open [TKO]”) and were compared to patients admitted during the preceding 6 months who were placed on a rate between 125 mL/h to 150 mL/h (non-TKO). The primary outcomes were ICU, hospital, and ventilator days.

Results

A total of 101 trauma patients met inclusion criteria: 56 (55.4%) in the TKO and 45 (44.6%) in the non-TKO group. Overall, the 2 groups were similar in regard to age, Injury Severity Score, Acute Physiology and Chronic Health Evaluation IV scores, and the need for mechanical ventilation. TKO had no effect on renal function compared to non-TKO with similarities in maximum hospital creatinine. TKO patients had lower ICU stay (2.7 ± 1.5 vs 4.1 ± 4.6 days; P = .03) and ventilator days (1.4 ± 0.5 vs 5.5 ± 4.8 days; P < .01).

Conclusions

A protocol that encourages admission basal fluid rate of TKO or 30 mL/h in normotensive trauma patients is safe, reduces fluid intake, and may be associated with a shorter intensive care unit course and fewer ventilator days.