• George Kasotakis, Antonis Sideris, Yuchiao Yang, Marc de Moya, Hasan Alam, David R King, Ronald Tompkins, George Velmahos, and Inflammation and Host Response to Injury Investigators.
• Division of Trauma, Emergency Surgery, and Critical Care, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. gkasotakis@mail.harvard.edu
• J Trauma Acute Care Surg. 2013 May 1;74(5):1215-21; discussion 1221-2.

BackgroundEvidence suggests that aggressive crystalloid resuscitation is associated with significant morbidity in various clinical settings. We wanted to assess whether aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients.MethodsData were derived from the Glue Grant database. Our primary outcome measure was all-cause in-hospital mortality. Secondary outcomes included days on mechanical ventilation; intensive care unit (ICU) and hospital length of stay (LOS); inflammatory (acute lung injury and adult respiratory distress syndrome, or multiple-organ failure) and resuscitation-related morbidity (abdominal and extremity compartment syndromes or acute renal failure) and nosocomial infections (ventilator-associated pneumonia, bloodstream, urinary tract, and surgical site infections).ResultsIn our sample of 1,754 patients, in-hospital mortality was not affected, but ventilator days (p < 0.001) as well as ICU (p = 0.009) and hospital (p = 0.002) LOS correlated strongly with the amount of crystalloids infused in the first 24 hours after injury. Amount of crystalloid resuscitation was also associated with the development of adult respiratory distress syndrome (p < 0.001), multiple-organ failure (p < 0.001), bloodstream (p = 0.001) and surgical site infections (p < 0.001), as well as abdominal (p < 0.001) and extremity compartment syndromes (p = 0.028) in a dose-dependent fashion, when age, Glasgow Coma Scale (GCS), severity of injury and acute physiologic derangement, comorbidities, as well as colloid and blood product transfusions were controlled for.ConclusionCrystalloid resuscitation is associated with a substantial increase in morbidity, as well as ICU and hospital LOS in adult blunt trauma patients.

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