Benefits of Initial Limited Crystalloid Resuscitation in Severely Injured Trauma Patients at Emergency Department.

Autor:	Wang H; Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA., Robinson RD; Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA., Phillips JL; Department of Surgery, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA., Kirk AJ; Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA., Duane TM; Department of Surgery, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA., Umejiego J; Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA., Stanzer M; Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA., Campbell-Furtick MB; Department of Surgery, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA., Zenarosa NR; Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
Jazyk:	angličtina
Zdroj:	Journal of clinical medicine research [J Clin Med Res] 2015 Dec; Vol. 7 (12), pp. 947-55. Date of Electronic Publication: 2015 Oct 23.
DOI:	10.14740/jocmr2355w
Abstrakt:	Background: Whether initial limited crystalloid resuscitation (LCR) benefits to all severely injured trauma patients receiving blood transfusions at emergency department (ED) is uncertain. We aimed to determine the role of LCR and its associations with packed red blood cell (PRBC) transfusion during initial resuscitation. Methods: Trauma patients receiving blood transfusions were reviewed from 2004 to 2013. Patients with LCR (L group, defined as < 2,000 mL) and excessive crystalloid resuscitation (E group, defined as ≥ 2,000 mL) were compared separately in terms of basic demographic, clinical variables, and hospital outcomes. Logistic regression, R-square (R(2)), and Spearman rho correlation were used for analysis. Results: A total of 633 patients were included. The mortality was 51% in L group and 45% in E group (P = 0.11). No statistically significant difference was found in terms of basic demographics, vital signs upon arrival at ED, or injury severity between the groups. The volume of blood transfused strongly correlated with the volume of crystalloid infused in E group (R(2) = 0.955). Crystalloid to PRBC (C/PRBC) ratio was 0.8 in L group and 1.3 in E group (P < 0.01). The correlations between C/PRBC and ED versus ICU versus hospital length of stay (LOS) via Spearman rho were 0.25, 0.22, and 0.22, respectively. Conclusions: Similar outcomes were observed in trauma patients receiving blood transfusions regardless of the crystalloid infusion volume. More crystalloid infusions were associated with more blood transfusions. The C/PRBC did not demonstrate predictive value regarding mortality but might predict LOS in severely injured trauma patients.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu