Paediatric Critical Care Medicine, University of Western Ontario, London, ON, Canada.
Injury. 2012 Dec;43(12):2078-82. doi: 10.1016/j.injury.2012.01.012. Epub 2012 Feb 4.
Trauma is a major cause of paediatric morbidity and mortality, yet knowledge of fluid resuscitation is limited. Our objectives were to determine current practises in resuscitation volume (RV) administered to paediatric non-haemorrhagic (NH) blunt trauma patients and to identify fluid related complications.
We examined data from 139 trauma patients 1-17 years of age with an injury severity score ≥ 12 resuscitated at a Trauma-designated Children's Hospital. Patients were separated into discreet groups based on ATLS age-dependent vital functions: toddler/preschooler (1-5 years), school age (6-12 years) and adolescent (13-17 years).
The median RV (total fluid intake-maintenance fluid intake) in ml/kg over the first 24h from the time of trauma by age was: 24 (IQR=19-47; 1-5 years); 26 (IQR=15-36; 6-12 years); and 22 (IQR=14-42; 13-17 years). The differences in RV/kg/24h following NH trauma was not significantly different between age groups (p=0.41). Urine output over the 24h ranged from 2.5 (IQR=1.9-3.3; lower age group) to 1.8 (IQR=1.2-2.4; upper age group) ml/kg/h; greater than the ATLS recommended age-dependent targets. Haematocrit was the only significant independent predictor of RV/kg/24h (p<0.001). Fluid-related complications attributable to RV were identified in 12% (n=17/139) of patients, and included ascites (8%; n=11/139) and/or pleural effusion(s) (9%; n=13/139). Patients with fluid-related complications received significantly more RV in ml/kg/24h (42, IQR=27-76) than those without complications (22, IQR=14-36; p=0.001).
The range of median RV administered to paediatric NH blunt trauma patients with ISS ≥ 12 was 22-26 ml/kg/24h. The RV administered was excessive based on high urine outputs and the presence of fluid-related complications. Further evaluation of RV triggers and endpoints used by paediatric traumatologists is required.
创伤是导致儿科发病率和死亡率的主要原因，但人们对液体复苏的了解有限。我们的目的是确定对非出血性（NH）钝性创伤儿科患者进行的复苏量（RV）的当前实践，并确定与液体相关的并发症。
我们检查了在一家创伤指定的儿童医院接受治疗、损伤严重程度评分≥12 的 139 名 1-17 岁创伤患者的数据。根据 ATLS 年龄相关的生命功能，将患者分为不同的组：幼儿/学龄前儿童（1-5 岁）、学龄儿童（6-12 岁）和青少年（13-17 岁）。
创伤后 24 小时内，按年龄划分的每公斤 RV（总液体摄入-维持液体摄入）中位数为：24（IQR=19-47；1-5 岁）；26（IQR=15-36；6-12 岁）；22（IQR=14-42；13-17 岁）。NH 创伤后 24 小时内 RV/kg/24h 差异在年龄组之间无显著差异（p=0.41）。24 小时内尿量范围为 2.5（IQR=1.9-3.3；年龄较小组）至 1.8（IQR=1.2-2.4；年龄较大组）ml/kg/h；大于 ATLS 推荐的年龄相关目标。血球比容是 RV/kg/24h 的唯一显著独立预测因子（p<0.001）。由于 RV 引起的与液体相关的并发症在 12%（n=17/139）的患者中被确定，包括腹水（8%；n=11/139）和/或胸腔积液（9%；n=13/139）。有液体相关并发症的患者接受的 RV/kg/24h 明显更多（42，IQR=27-76）比没有并发症的患者（22，IQR=14-36；p=0.001）。
接受 ISS≥12 的儿科 NH 钝性创伤患者的 RV 中位数范围为 22-26 ml/kg/24h。根据高尿量和液体相关并发症的存在，RV 给药过多。需要进一步评估儿科创伤学家使用的 RV 触发因素和终点。
