Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Int J Surg. 2017 Feb;38:78-82. doi: 10.1016/j.ijsu.2016.12.073. Epub 2016 Dec 28.
Liberal emergency department (ED) resuscitation after trauma may lead to uncontrolled hemorrhage, reduced organ perfusion, and compartment syndrome. Recent guidelines reduced the standard starting point for crystalloid resuscitation from 2 L to 1 L and emphasized "balanced" resuscitation. The purpose of this study was to characterize how an urban, Level 1 trauma center has responded to changes in crystalloid resuscitation practices over time and to describe associated patient outcomes.
This is a retrospective review of trauma patients who sustained moderate to severe injury (ISS > 9) and received crystalloid resuscitation in the ED during 1/2004-12/2013 at an urban, Level 1 trauma center. Patient data collected included age, gender, Glasgow Coma Scale (GCS) score, initial systolic blood pressure (SBP), mechanism of injury, regional Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), volume of blood products and crystalloids administered in the ED. Patients who received <2 L of crystalloid were considered low-volume while those who received ≥2 L were high-volume patients. Clinical characteristics and outcomes were compared between high- and low-volume cohorts, and multivariate regression was used to adjust for confounders. Trend analysis examined changes in variables over time.
1571 moderate to severely injured patients received crystalloid resuscitation; 1282 (82%) were low-volume and 289 (18%) were high-volume. Compared to high-volume patients, low-volume patients presented with a higher median SBP (134 vs. 122 mmHg, p < 0.001) and GCS (15 vs. 14, p < 0.001). Low-volume patients also had lower median ISS (15 vs. 19, p < 0.001). Unadjusted mortality was lower in the low-volume cohort (7% vs. 19%, p < 0.001). Multivariate analysis demonstrated that high-volume patients had increased odds of mortality compared to low-volume patients (AOR 1.88, p = 0.008). Decreased rates of high-volume resuscitation and overall mortality were demonstrated over the 10-year study period.
The observed decrease in high-volume crystalloid resuscitations in the ED paralleled a reduction in mortality over the ten-year period. In addition, adjusted mortality was higher in those receiving high-volume resuscitation.
创伤后自由的急诊复苏可能导致无法控制的出血、器官灌注减少和间隔综合征。最近的指南将晶体复苏的标准起始点从 2L 减少到 1L，并强调“平衡”复苏。本研究的目的是描述一个城市一级创伤中心如何随着时间的推移对晶体复苏实践的变化做出反应，并描述相关的患者结局。
这是对 2004 年 1 月至 2013 年 12 月期间在城市一级创伤中心接受中度至重度损伤（ISS>9）并在急诊科接受晶体复苏的创伤患者进行的回顾性研究。收集的患者数据包括年龄、性别、格拉斯哥昏迷评分（GCS）、初始收缩压（SBP）、损伤机制、区域损伤严重程度评分（AIS）、损伤严重程度评分（ISS）、在急诊科输注的血液制品和晶体的量。接受<2L 晶体的患者被认为是低容量，而接受≥2L 晶体的患者是高容量患者。比较高容量和低容量两组的临床特征和结局，并进行多变量回归以调整混杂因素。趋势分析检查了变量随时间的变化。
1571 名中度至重度受伤患者接受了晶体复苏；1282 名（82%）为低容量，289 名（18%）为高容量。与高容量患者相比，低容量患者的中位 SBP（134 与 122mmHg，p<0.001）和 GCS（15 与 14，p<0.001）更高。低容量患者的中位 ISS 也较低（15 与 19，p<0.001）。低容量组未调整死亡率较低（7%与 19%，p<0.001）。多变量分析表明，与低容量患者相比，高容量患者的死亡率增加（优势比 1.88，p=0.008）。在 10 年的研究期间，高容量复苏和总体死亡率的发生率均有所下降。
在 10 年的研究期间，观察到急诊科高容量晶体复苏的减少与死亡率的降低相平行。此外，接受高容量复苏的患者调整后的死亡率更高。
