The volume of infusion fluids correlates with treatment outcomes in critically ill trauma patients

Anna Wrzosek; Tomasz Drygalski; Jarosław Garlicki; Jarosław Woroń; Wojciech Szpunar; Maciej Polak; Jakub Droś; Jerzy Wordliczek; Renata Zajączkowska

doi:10.3389/fmed.2022.1040098

The volume of infusion fluids correlates with treatment outcomes in critically ill trauma patients

Front Med (Lausanne). 2023 Jan 12:9:1040098. doi: 10.3389/fmed.2022.1040098. eCollection 2022.

Authors

Anna Wrzosek^{1

2}, Tomasz Drygalski^{2

3}, Jarosław Garlicki^{1

2}, Jarosław Woroń^{1

2

4}, Wojciech Szpunar², Maciej Polak⁵, Jakub Droś^{2

6}, Jerzy Wordliczek^{1

2}, Renata Zajączkowska¹

Affiliations

¹ Department of Interdisciplinary Intensive Care, Jagiellonian University Medical College, Kraków, Poland.
² Department of Anaesthesiology and Intensive Therapy, University Hospital, Kraków, Poland.
³ Department of Anaesthesiology and Intensive Therapy, Jagiellonian University Medical College, Kraków, Poland.
⁴ Department of Clinical Pharmacology, Medical College, Jagiellonian University, Kraków, Poland.
⁵ Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Kraków, Poland.
⁶ Doctoral School in Medical and Health Sciences, Jagiellonian University Medical College, Kraków, Poland.

Abstract

Background: Appropriate fluid management is essential in the treatment of critically ill trauma patients. Both insufficient and excessive fluid volume can be associated with worse outcomes. Intensive fluid resuscitation is a crucial element of early resuscitation in trauma; however, excessive fluid infusion may lead to fluid accumulation and consequent complications such as pulmonary edema, cardiac failure, impaired bowel function, and delayed wound healing. The aim of this study was to examine the volumes of fluids infused in critically ill trauma patients during the first hours and days of treatment and their relationship to survival and outcomes.

Methods: We retrospectively screened records of all consecutive patients admitted to the intensive care unit (ICU) from the beginning of 2019 to the end of 2020. All adults who were admitted to ICU after trauma and were hospitalized for a minimum of 2 days were included in the study. We used multivariate regression analysis models to assess a relationship between volume of infused fluid or fluid balance, age, ISS or APACHE II score, and mortality. We also compared volumes of fluids in survivors and non-survivors including additional analyses in subgroups depending on disease severity (ISS score, APACHE II score), blood loss, and age.

Results: A total of 52 patients met the inclusion criteria for the study. The volume of infused fluids and fluid balance were positively correlated with mortality, complication rate, time on mechanical ventilation, length of stay in the ICU, INR, and APTT. Fluid volumes were significantly higher in non-survivors than in survivors at the end of the second day of ICU stay (2.77 vs. 2.14 ml/kg/h) and non-survivors had a highly positive fluid balance (6.21 compared with 2.48 L in survivors).

Conclusion: In critically ill trauma patients, worse outcomes were associated with higher volumes of infusion fluids and a more positive fluid balance. Although fluid resuscitation is lifesaving, especially in the first hours after trauma, fluid infusion should be limited to a necessary minimum to avoid fluid overload and its negative consequences.

Keywords: cardiac failure; critical illness; fluid overload; fluid resuscitation; injury; pulmonary edema; trauma.