Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome.
OBJECTIVE
Normal resuscitation (oxygen delivery index [DO2I] >/=500 mL/min per square meter), compared with supranormal trauma resuscitation (DO2I >/=600 mL/min per square meter), requires less crystalloid volume, thus decreasing the incidence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS).


METHODS
Retrospective analysis of a prospective database.


METHODS
Twenty-bed intensive care unit (ICU) in a regional level I trauma center.


METHODS
Patients with major trauma (injury severity score >15, initial base deficit >/=6 mEq/L, or need for >/=6 units of packed red blood cells in the first 12 hours) or age 65 years or older with any 2 of the previous criteria.


METHODS
Shock/trauma resuscitation protocol: pulmonary artery catheter, gastric tonometry, urinary bladder pressure measurements, lactated Ringer infusion, packed red blood cell transfusion, and moderate inotrope support, as needed, in that sequence, to attain and maintain a DO2I greater than or equal to 600 mL/min per m2 (16 months, ending January 1, 2001, n = 85) or a DO2I greater than or equal to 500 mL/min per square meter (16 months, starting January 1, 2001, n = 71) for the first 24 hours in the ICU.


METHODS
Lactated Ringer infusion volume (liters) at ICU admission, gastric partial carbon dioxide minus end-tidal carbon dioxide(GAPCO2), IAH (urinary bladder pressure measurements >20 mm Hg), ACS (urinary bladder pressure measurements >25 mm Hg with organ dysfunction), multiple organ failure, and mortality.


RESULTS
Demographics, injury severity, and shock severity parameters were similar in both groups. The supranormal resuscitation group required more lactated Ringer infusion volume in the first 24 hours in the ICU (mean +/- SD, 13 +/- 2 vs 7 +/- 1 L; P<.05) and had higher GAPCO2 (16 +/- 2 vs 7 +/- 1 mm Hg; P<.05). In the supranormal group, IAH (42% vs 20%; P<.05) and ACS (16% vs 8%; P<.05) were more frequent. The conventional trauma outcomes, such as multiple organ failure (22% vs 9%; P<.05) and mortality (27% vs 11%; P<.05) were less favorable in the supranormal resuscitation group.


CONCLUSIONS
Supranormal resuscitation, compared with normal resuscitation, was associated with more lactated Ringer infusion, decreased intestinal perfusion (higher GAPCO2), and an increased incidence of IAH, ACS, multiple organ failure, and death.
Balogh
Zsolt
Z
Department of Surgery, Intensive Care Unit, Memorial Hermann Hospital, University of Texas-Houston Medical School, Houston, USA.
McKinley
Bruce A
BA
Cocanour
Christine S
CS
Kozar
Rosemary A
RA
Valdivia
Alicia
A
Sailors
R Matthew
RM
Moore
Frederick A
FA
D000005:Abdomen; D000007:Abdominal Injuries / Q000628:therapy*; D000328:Adult; D003161:Compartment Syndromes / Q000209:etiology*; D003422:Critical Care / Q000379:methods; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D007552:Isotonic Solutions; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D010952:Plasma Substitutes / Q000009:adverse effects*; D015532:Rehydration Solutions / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D015532:Rehydration Solutions