Aggressive Crystalloid Resuscitation Outcomes in Low-Severity Pediatric Trauma
| Autor: | Mark McKenney, John D. Ehrhardt, Dessy Boneva, Adel Elkbuli, Sarah Zajd |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Resuscitation medicine.medical_specialty Adolescent Fluid management Intensive Care Units Pediatric Retrospective database law.invention 03 medical and health sciences Injury Severity Score 0302 clinical medicine Trauma Centers Randomized controlled trial law medicine Humans Registries Child Retrospective Studies Cause of death Retrospective review Dose-Response Relationship Drug business.industry Trauma center Infant Newborn Infant Crystalloid Solutions Length of Stay medicine.disease Survival Analysis Treatment Outcome Child Preschool 030220 oncology & carcinogenesis Abbreviated Injury Scale Emergency medicine Fluid Therapy Wounds and Injuries Female 030211 gastroenterology & hepatology Surgery business Pediatric trauma |
| Zdroj: | Journal of Surgical Research. 247:350-355 |
| ISSN: | 0022-4804 |
| Popis: | Trauma is the leading cause of death among children. Studies have found that insufficient intravenous (IV) fluid resuscitation contributes significantly to morbidity and mortality in pediatric trauma. While large-volume resuscitation represents a potential solution, overly aggressive fluid management may complicate hospitalizations and recovery. Through this study, we aim to evaluate the impact of aggressive fluid resuscitation on outcomes in pediatric trauma.This is a retrospective review utilizing our level I trauma center registry for pediatric patients aged16 y admitted from 2014 to 2017. Patients transferred from our center within 24 h and those who arrived from outside hospitals were excluded. Patients who received blood product transfusions were excluded. Included patients were divided into two crystalloid groups:60 mL/kg/24 h and ≥60 mL/kg/24 h. Outcome measures included ICU length-of-stay, length-of-hospitalization, complications, and mortality rate.Study sample included 320 patients (60 mL/kg/24 h = 219; ≥60 mL/kg/24 h = 101). The ≥60 mL/kg/24 h group was younger (9.95 versus 5.27, P = 0.0001). There were no significant differences in GCS on arrival, injury severity score, Abbreviated Injury Scale, Revised Trauma Scores, traumatic brain injury, and operative intervention between groups. Outcome measures showed there was no significant difference in 30-day readmission rate, complications, or mortality. Large-volume crystalloid resuscitation was associated with longer mean ICU length-of-stay (1.5 d versus 0.8 d, P = 0.004).In this single-institution retrospective database analysis, large-volume crystalloid resuscitation (≥60 mL/kg) was associated with a significant increase in ICU length-of-stay without survival benefit. More research in the form of randomized trials will help determine the optimal rate for fluid resuscitation in pediatric trauma patients while weighing potential critical care complications. |
| Databáze: | OpenAIRE |
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