|Restrictive fluid resuscitation in combination with damage control resuscitation: time for adaptation.|
|PMID: 22929496 Owner: NLM Status: MEDLINE|
|BACKGROUND: Damage control resuscitation (DCR) conveys a survival advantage in patients with severe hemorrhage. The role of restrictive fluid resuscitation (RFR) when used in combination with DCR has not been elucidated. We hypothesize that RFR, when used with DCR, conveys an overall survival benefit for patients with severe hemorrhage.
METHODS: This is a retrospective analysis from January 2007 to May 2011 at a Level I trauma center. Inclusion criteria included penetrating torso injuries, systolic blood pressure less than or equal to 90 mm Hg, and managed with DCR and damage control surgery (DCS). There were two groups according to the quantity of fluid before DCS: (1) standard fluid resuscitation (SFR) greater than or equal to 150 mL of crystalloid; (2) RFR less than 150 mL of crystalloid. Demographics and outcomes were analyzed.
RESULTS: Three hundred seven patients were included. Before DCS, 132 (43%) received less than 150 mL of crystalloids, grouped under RFR; and 175 (57%) received greater than or equal to 150 mL of crystalloids, grouped under SFR. Demographics and initial clinical characteristics were similar between the study groups. Compared with the SFR group, RFR patients received less fluid preoperatively (129 mL vs. 2,757 mL; p < 0.001), exhibited a lower intraoperative mortality (9% vs. 32%; p < 0.001), and had a shorter hospital length of stay (13 vs. 18 days; p = 0.02). Patients in the SFR group had a lower trauma intensive care unit mortality (5 vs. 12%; p = 0.03) but exhibited a higher overall mortality. Patients receiving RFR demonstrated a survival benefit, with an odds ratio for mortality of 0.69 (95% confidence interval, 0.37-0.91).
CONCLUSION: To the best of our knowledge, this is the first civilian study that analyzes the impact of RFR in patients managed with DCR. Its use in conjunction with DCR for hypotensive trauma patients with penetrating injuries to the torso conveys an overall and early intraoperative survival benefit.
LEVEL OF EVIDENCE: Therapeutic study, level IV.
|Marquinn D Duke; Chrissy Guidry; Jordan Guice; Lance Stuke; Alan B Marr; John P Hunt; Peter Meade; Norman E McSwain; Juan Carlos Duchesne|
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|Type: Comparative Study; Journal Article|
|Title: The journal of trauma and acute care surgery Volume: 73 ISSN: 2163-0763 ISO Abbreviation: J Trauma Acute Care Surg Publication Date: 2012 Sep|
|Created Date: 2012-08-29 Completed Date: 2012-11-20 Revised Date: 2013-09-25|
Medline Journal Info:
|Nlm Unique ID: 101570622 Medline TA: J Trauma Acute Care Surg Country: United States|
|Languages: eng Pagination: 674-8 Citation Subset: AIM; IM|
|Department of Surgery,Section of Trauma and Critical Care Surgery, Tulane University Health Science Center, New Orleans, Louisiana 70112, USA.|
|APA/MLA Format Download EndNote Download BibTex|
Combined Modality Therapy
Critical Illness / mortality, therapy
Fluid Therapy / methods*
Hemostasis, Surgical / methods*
Resuscitation / methods*, mortality
Shock, Hemorrhagic / diagnosis, etiology, mortality*, therapy*
Thoracic Injuries / complications, diagnosis, therapy
Thoracotomy / methods
Wounds, Penetrating / complications, diagnosis, therapy
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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