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Aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients: An analysis of the Glue Grant database

Kasotakis, George MD; Sideris, Antonis MD; Yang, Yuchiao PhD; de Moya, Marc MD; Alam, Hasan MD; King, David R. MD; Tompkins, Ronald MD, ScD; Velmahos, George MD, MsEd, PhDthe Inflammation and Host Response to Injury Investigators

Journal of Trauma and Acute Care Surgery: May 2013 - Volume 74 - Issue 5 - p 1215–1222
AAST 2012 Plenary Papers
Editor's Choice

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.

CONCLUSION: Crystalloid resuscitation is associated with a substantial increase in morbidity, as well as ICU and hospital LOS in adult blunt trauma patients.

LEVEL OF EVIDENCE: Therapeutic study, level III.

From the Division of Trauma, Emergency Surgery, and Critical Care, Massachusetts General Hospital, Boston, Massachusetts.

Submitted: August 3, 2012, Revised: November 30, 2012, Accepted: December 3, 2012.

This study was presented at the annual meeting of the American Association for the Surgery of Trauma, September 12–15, 2013, in Kauai, Hawaii.

Address for reprints: George Kasotakis, MD, Massachusetts General Hospital, Division of Trauma, Emergency Surgery and Surgical Critical Care, 165 Cambridge St., Suite 810, Boston, MA 02114; email:

© 2013 Lippincott Williams & Wilkins, Inc.