Abstract：
OBJECTIVE: The temporal trends of crystalloid resuscitation in severely injured trauma patients after ICU admission are not well characterized. We hypothesized early crystalloid resuscitation was associated with less volume and better outcomes than delaying crystalloid.
METHODS: Retrospective, observational.
METHODS: High-volume level 1 academic trauma center.
METHODS: Adult trauma patients admitted to the ICU with emergency department serum lactate greater than or equal to 4 mmol/dL, elevated lactate (≥ 2 mmol/L) at ICU admission, and normal lactate by 48 hours.
METHODS: None.
RESULTS: For the 333 subjects, we analyzed patient and injury characteristics and the first 48 hours of ICU course. Receipt of greater than or equal to 500 mL/hr of crystalloid in the first 6 hours of ICU admission was used to distinguish early vs. late resuscitation. Outcomes included ICU length of stay (LOS), ventilator days, and acute kidney injury (AKI). Unadjusted and multivariable regression methods were used to compare early resuscitation vs. late resuscitation. Compared with the early resuscitation group, the late resuscitation group received more volume by 48 hours (5.5 vs. 4.1 L; p ≤ 0.001), had longer ICU LOS (9 vs. 5 d; p ≤ 0.001), more ventilator days (5 vs. 2 d; p ≤ 0.001), and higher occurrence rate of AKI (38% vs. 11%; p ≤ 0.001). On multivariable regression, late resuscitation remained associated with longer ICU LOS and ventilator days and higher odds of AKI.
CONCLUSIONS: Delaying resuscitation is associated with both higher volumes of crystalloid by 48 hours and worse outcomes compared with early resuscitation. Judicious crystalloid given early in ICU admission could improve outcomes in the severely injured.
METHODS: Retrospective, observational.
METHODS: High-volume level 1 academic trauma center.
METHODS: Adult trauma patients admitted to the ICU with emergency department serum lactate greater than or equal to 4 mmol/dL, elevated lactate (≥ 2 mmol/L) at ICU admission, and normal lactate by 48 hours.
METHODS: None.
RESULTS: For the 333 subjects, we analyzed patient and injury characteristics and the first 48 hours of ICU course. Receipt of greater than or equal to 500 mL/hr of crystalloid in the first 6 hours of ICU admission was used to distinguish early vs. late resuscitation. Outcomes included ICU length of stay (LOS), ventilator days, and acute kidney injury (AKI). Unadjusted and multivariable regression methods were used to compare early resuscitation vs. late resuscitation. Compared with the early resuscitation group, the late resuscitation group received more volume by 48 hours (5.5 vs. 4.1 L; p ≤ 0.001), had longer ICU LOS (9 vs. 5 d; p ≤ 0.001), more ventilator days (5 vs. 2 d; p ≤ 0.001), and higher occurrence rate of AKI (38% vs. 11%; p ≤ 0.001). On multivariable regression, late resuscitation remained associated with longer ICU LOS and ventilator days and higher odds of AKI.
CONCLUSIONS: Delaying resuscitation is associated with both higher volumes of crystalloid by 48 hours and worse outcomes compared with early resuscitation. Judicious crystalloid given early in ICU admission could improve outcomes in the severely injured.
摘要：
目的：严重创伤患者入住ICU后晶体复苏的时间趋势尚不清楚。我们假设早期晶体复苏与延迟晶体复苏相比，体积更小，结局更好。
方法：回顾性，观察。
方法：高容量1级学术创伤中心。
方法：急诊ICU收治的成年创伤患者血清乳酸大于或等于4mmol/dL，ICU入院时乳酸升高（≥2mmol/L），和正常的乳酸48小时。
方法：无。
结果：对于333名受试者，我们分析了患者和损伤特征以及ICU前48小时的病程.ICU入院前6小时接受大于或等于500毫升/小时的晶体用于区分早期和早期晚期复苏.结果包括ICU住院时间（LOS），呼吸机日，急性肾损伤（AKI）。未调整和多变量回归方法用于比较早期复苏与晚期复苏.与早期复苏组相比，晚期复苏组48小时接受更多的容量(5.5vs.4.1L;p≤0.001),有更长的ICULOS（9vs.5d；p≤0.001)，更多呼吸机天数(5vs.2d；p≤0.001)，AKI发生率较高(38%vs.11%；p≤0.001）。在多元回归中，晚期复苏仍与较长的ICULOS和呼吸机天数以及较高的AKI几率相关.
结论：与早期复苏相比，延迟复苏与48小时内更高的晶体量和更差的结局相关。在ICU入院早期给予明智的晶体液可改善严重受伤患者的预后。
方法：回顾性，观察。
方法：高容量1级学术创伤中心。
方法：急诊ICU收治的成年创伤患者血清乳酸大于或等于4mmol/dL，ICU入院时乳酸升高（≥2mmol/L），和正常的乳酸48小时。
方法：无。
结果：对于333名受试者，我们分析了患者和损伤特征以及ICU前48小时的病程.ICU入院前6小时接受大于或等于500毫升/小时的晶体用于区分早期和早期晚期复苏.结果包括ICU住院时间（LOS），呼吸机日，急性肾损伤（AKI）。未调整和多变量回归方法用于比较早期复苏与晚期复苏.与早期复苏组相比，晚期复苏组48小时接受更多的容量(5.5vs.4.1L;p≤0.001),有更长的ICULOS（9vs.5d；p≤0.001)，更多呼吸机天数(5vs.2d；p≤0.001)，AKI发生率较高(38%vs.11%；p≤0.001）。在多元回归中，晚期复苏仍与较长的ICULOS和呼吸机天数以及较高的AKI几率相关.
结论：与早期复苏相比，延迟复苏与48小时内更高的晶体量和更差的结局相关。在ICU入院早期给予明智的晶体液可改善严重受伤患者的预后。
