Barbara E Coons1, Sophia Tam2, Jeanne Rubsam3, Steven Stylianos4, Vincent Duron5. 1. Columbia University Department of Surgery, New York-Presbyterian Hospital, Milstein Hospital Building, 7GS 313, 177 Fort Washington Avenue, New York, NY 10032. Electronic address: bc2486@cumc.columbia.edu. 2. Columbia University Department of Surgery, New York-Presbyterian Hospital, Milstein Hospital Building, 7GS 313, 177 Fort Washington Avenue, New York, NY 10032. Electronic address: st2975@cumc.columbia.edu. 3. Morgan Stanley Children's Hospital/New York-Presbyterian, Division of Pediatric Surgery, Columbia University College of Physicians & Surgeons, 3959 Broadway, CHN 215, New York, NY 10032. Electronic address: jmr19@cumc.columbia.edu. 4. Morgan Stanley Children's Hospital/New York-Presbyterian, Division of Pediatric Surgery, Columbia University College of Physicians & Surgeons, 3959 Broadway, CHN 215, New York, NY 10032. Electronic address: ss128@cumc.columbia.edu. 5. Morgan Stanley Children's Hospital/New York-Presbyterian, Division of Pediatric Surgery, Columbia University College of Physicians & Surgeons, 3959 Broadway, CHN 215, New York, NY 10032. Electronic address: vd2312@cumc.columbia.edu.
Abstract
BACKGROUND: Aggressive fluid resuscitative strategies have been the cornerstone of early trauma management for decades. However, recent prospective adult studies have challenged this practice, underlining the detrimental effect of positive fluid balance on cardiopulmonary function. Fluid overload has been associated with impaired oxygenation and morbidity in critically ill adults, but data is lacking in pediatric trauma patients. METHODS: We completed a retrospective chart review of all pediatric trauma patients 0-18 years old admitted to a level 1 trauma center from January 2013 to December 2015. Four patient cohorts were established based on volume of fluid administered: <20 ml/kg/day, 20-40 ml/kg/day, 40-60 ml/kg/day, and > 60 ml/kg/day. The primary outcome was death. Secondary outcomes included the number of days on the ventilator, intensive care unit length of stay (ICU LOS), overall length of stay (LOS), number of days nil per os (NPO) as an indicator of ileus, and incidence of bloodstream infection and/or surgical site infection. RESULTS: The mean volume of fluid administered over the first 24 h was 41 ml/kg/day, and 28 ml/kg/day over the first 48 h. ICU length of stay and overall length of stay were increased in patients who received more than 60 ml/kg/day in the first 24 h of their hospitalization. Furthermore, ventilator use, ICU length of stay, overall length of stay, and time to resumption of a regular diet were all increased in patients who received >60 ml/kg/day over 48 h. CONCLUSIONS: Early administration of high volumes of crystalloid fluid greater than 60 ml/kg/day significantly correlates with pulmonary complications, days NPO, and hospital length of stay. These results span the first 48 h of a patient's hospital stay and should encourage surgical care providers to exercise judicious use of crystalloid fluid administration in the trauma bay, ICU, and floor. TYPE OF STUDY: Therapeutic. LEVEL OF EVIDENCE: Level III.
BACKGROUND: Aggressive fluid resuscitative strategies have been the cornerstone of early trauma management for decades. However, recent prospective adult studies have challenged this practice, underlining the detrimental effect of positive fluid balance on cardiopulmonary function. Fluid overload has been associated with impaired oxygenation and morbidity in critically ill adults, but data is lacking in pediatric traumapatients. METHODS: We completed a retrospective chart review of all pediatric traumapatients 0-18 years old admitted to a level 1 trauma center from January 2013 to December 2015. Four patient cohorts were established based on volume of fluid administered: <20 ml/kg/day, 20-40 ml/kg/day, 40-60 ml/kg/day, and > 60 ml/kg/day. The primary outcome was death. Secondary outcomes included the number of days on the ventilator, intensive care unit length of stay (ICU LOS), overall length of stay (LOS), number of days nil per os (NPO) as an indicator of ileus, and incidence of bloodstream infection and/or surgical site infection. RESULTS: The mean volume of fluid administered over the first 24 h was 41 ml/kg/day, and 28 ml/kg/day over the first 48 h. ICU length of stay and overall length of stay were increased in patients who received more than 60 ml/kg/day in the first 24 h of their hospitalization. Furthermore, ventilator use, ICU length of stay, overall length of stay, and time to resumption of a regular diet were all increased in patients who received >60 ml/kg/day over 48 h. CONCLUSIONS: Early administration of high volumes of crystalloid fluid greater than 60 ml/kg/day significantly correlates with pulmonary complications, days NPO, and hospital length of stay. These results span the first 48 h of a patient's hospital stay and should encourage surgical care providers to exercise judicious use of crystalloid fluid administration in the trauma bay, ICU, and floor. TYPE OF STUDY: Therapeutic. LEVEL OF EVIDENCE: Level III.
Authors: Ian K Maconochie; Richard Aickin; Mary Fran Hazinski; Dianne L Atkins; Robert Bingham; Thomaz Bittencourt Couto; Anne-Marie Guerguerian; Vinay M Nadkarni; Kee-Chong Ng; Gabrielle A Nuthall; Gene Y K Ong; Amelia G Reis; Stephen M Schexnayder; Barnaby R Scholefield; Janice A Tijssen; Jerry P Nolan; Peter T Morley; Patrick Van de Voorde; Arno L Zaritsky; Allan R de Caen Journal: Resuscitation Date: 2020-10-21 Impact factor: 5.262
Authors: Jerry P Nolan; Ian Maconochie; Jasmeet Soar; Theresa M Olasveengen; Robert Greif; Myra H Wyckoff; Eunice M Singletary; Richard Aickin; Katherine M Berg; Mary E Mancini; Farhan Bhanji; Jonathan Wyllie; David Zideman; Robert W Neumar; Gavin D Perkins; Maaret Castrén; Peter T Morley; William H Montgomery; Vinay M Nadkarni; John E Billi; Raina M Merchant; Allan de Caen; Raffo Escalante-Kanashiro; David Kloeck; Tzong-Luen Wang; Mary Fran Hazinski Journal: Resuscitation Date: 2020-10-21 Impact factor: 6.251