title: Decreasing maintenance fluids in normotensive trauma patients may reduce intensive care unit stay and ventilator days.
abstract: OBJECTIVE
  The purpose of the study is to determine if excessive fluid administration is associated with a prolonged hospital course and worse outcomes.
  
  
  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.
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Galinos.Barmparas@cshs.org.
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Ara.Ko@cshs.org.
authors.forename: Ara
authors.initials: A
authors.lastname: Ko
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Megan.Harada@cshs.org.
authors.forename: Megan Y
authors.initials: MY
authors.lastname: Harada
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Andrea.zaw@cshs.org.
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Zaw
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Jason.murry@cshs.org.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Murry
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: e.73.smith@gmail.com.
authors.forename: Eric J T
authors.initials: EJ
authors.lastname: Smith
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Sogol.ashrafian@cshs.org.
authors.forename: Sogol
authors.initials: S
authors.lastname: Ashrafian
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Beatrice.sun@cshs.org.
authors.forename: Beatrice J
authors.initials: BJ
authors.lastname: Sun
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Eric.ley@cshs.org.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ley
mesh_terms: D018806:APACHE; D015998:Abbreviated Injury Scale; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D065386:Historically Controlled Study; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007552:Isotonic Solutions; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions
keywords: Fluid balance; Fluid resuscitation; Maintenance fluid rate; Normotensive; To keep open