title: Aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients: an analysis of the Glue Grant database.
abstract: BACKGROUND
  Evidence 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.
  
  
  METHODS
  Data 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).
  
  
  RESULTS
  In 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.
  
  
  CONCLUSIONS
  Crystalloid resuscitation is associated with a substantial increase in morbidity, as well as ICU and hospital LOS in adult blunt trauma patients.
authors.affiliation: Division of Trauma, Emergency Surgery, and Critical Care, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. gkasotakis@mail.harvard.edu
authors.forename: George
authors.initials: G
authors.lastname: Kasotakis
authors.forename: Antonis
authors.initials: A
authors.lastname: Sideris
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Yang
authors.forename: Marc
authors.initials: M
authors.lastname: de Moya
authors.forename: Hasan
authors.initials: H
authors.lastname: Alam
authors.forename: David R
authors.initials: DR
authors.lastname: King
authors.forename: Ronald
authors.initials: R
authors.lastname: Tompkins
authors.forename: George
authors.initials: G
authors.lastname: Velmahos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077324:Crystalloid Solutions; D016208:Databases, Factual; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D011446:Prospective Studies; D015532:Rehydration Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012151:Resuscitation / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy*; D055815:Young Adult
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D015532:Rehydration Solutions