Galinos Barmparas1, Ara Ko2, Megan Y Harada3, Andrea A Zaw4, Jason S Murry5, Eric J T Smith6, Sogol Ashrafian7, Beatrice J Sun8, Eric J Ley9. 1. Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Galinos.Barmparas@cshs.org. 2. Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Ara.Ko@cshs.org. 3. Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Megan.Harada@cshs.org. 4. Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Andrea.zaw@cshs.org. 5. Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Jason.murry@cshs.org. 6. Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: e.73.smith@gmail.com. 7. Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Sogol.ashrafian@cshs.org. 8. Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Beatrice.sun@cshs.org. 9. Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Eric.ley@cshs.org.
Abstract
PURPOSE: The purpose of the study is to determine if excessive fluid administration is associated with a prolonged hospital course and worse outcomes. MATERIALS AND METHODS: In July 2013, all normotensive trauma patients admitted to the surgical intensive care unit (ICU) were administered crystalloids at 30 mL/h ("to keep open [TKO]") and were compared to patients admitted during the preceding 6 months who were placed on a rate between 125 mL/h to 150 mL/h (non-TKO). The primary outcomes were ICU, hospital, and ventilator days. RESULTS: A total of 101 trauma patients met inclusion criteria: 56 (55.4%) in the TKO and 45 (44.6%) in the non-TKO group. Overall, the 2 groups were similar in regard to age, Injury Severity Score, Acute Physiology and Chronic Health Evaluation IV scores, and the need for mechanical ventilation. TKO had no effect on renal function compared to non-TKO with similarities in maximum hospital creatinine. TKO patients had lower ICU stay (2.7 ± 1.5 vs 4.1 ± 4.6 days; P = .03) and ventilator days (1.4 ± 0.5 vs 5.5 ± 4.8 days; P < .01). CONCLUSIONS: A protocol that encourages admission basal fluid rate of TKO or 30 mL/h in normotensive trauma patients is safe, reduces fluid intake, and may be associated with a shorter intensive care unit course and fewer ventilator days.
PURPOSE: The purpose of the study is to determine if excessive fluid administration is associated with a prolonged hospital course and worse outcomes. MATERIALS AND METHODS: In July 2013, all normotensive traumapatients admitted to the surgical intensive care unit (ICU) were administered crystalloids at 30 mL/h ("to keep open [TKO]") and were compared to patients admitted during the preceding 6 months who were placed on a rate between 125 mL/h to 150 mL/h (non-TKO). The primary outcomes were ICU, hospital, and ventilator days. RESULTS: A total of 101 traumapatients met inclusion criteria: 56 (55.4%) in the TKO and 45 (44.6%) in the non-TKO group. Overall, the 2 groups were similar in regard to age, Injury Severity Score, Acute Physiology and Chronic Health Evaluation IV scores, and the need for mechanical ventilation. TKO had no effect on renal function compared to non-TKO with similarities in maximum hospital creatinine. TKO patients had lower ICU stay (2.7 ± 1.5 vs 4.1 ± 4.6 days; P = .03) and ventilator days (1.4 ± 0.5 vs 5.5 ± 4.8 days; P < .01). CONCLUSIONS: A protocol that encourages admission basal fluid rate of TKO or 30 mL/h in normotensive traumapatients is safe, reduces fluid intake, and may be associated with a shorter intensive care unit course and fewer ventilator days.
Authors: W Anthony Hawkins; Susan E Smith; Andrea Sikora Newsome; John R Carr; Christopher M Bland; Trisha N Branan Journal: J Pharm Pract Date: 2019-06-30