Variability of intravenous fluid administration during exploratory laparotomy

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We sought to determine the types of crystalloid used during trauma laparotomies and the potential effects on resuscitation” Baker et al (2018).

Abstract:

BACKGROUND: Approximately 8% of traumatically injured patients require transfusion with packed red blood cells (pRBC) and only 1% to 2% require massive transfusion. Intraoperative massive transfusion was defined as requiring greater than 5 units (u) of pRBC in 4 hours. Despite the majority of patients not requiring transfusion, the appropriate amount and type of crystalloid administered during the era of damage control resuscitation have not been analyzed. We sought to determine the types of crystalloid used during trauma laparotomies and the potential effects on resuscitation.

METHODS: Patients who underwent laparotomy after abdominal trauma from January 2014 to December 2016 at the University of Cincinnati Medical Center were identified. Patients were grouped based on requiring 0u, 1u to 4u, and ≥5u pRBC during intraoperative resuscitation. Demographic, physiologic, pharmacologic, operative, and postoperative data were collected. Statistical analysis was performed with Kruskal-Wallis test and Pearson’s correlation coefficient.

RESULTS: Lactated Ringer’s (LR) solution was the most used crystalloid type received in the 0u and 1u to 4u pRBC cohorts, whereas normal saline (NS) was the most common in the ≥5u pRBC cohort. Most patients received two types of crystalloid intraoperatively. NS and LR were most frequently the first crystalloids administered, with Normosol infusion occurring later. The amount of crystalloid received correlated with operative length, but did not correlate with the estimated blood loss. Neither the type of crystalloid administered nor the anesthesia provider type was associated with changes in postoperative resuscitation parameters or electrolyte concentrations.

DISCUSSION: There is a wide variation in the amount and types of crystalloids administered during exploratory laparotomy for trauma. Interestingly, the amount or type of crystalloid given did not affect resuscitation parameters regardless of blood product requirement.

LEVEL OF EVIDENCE: Level IV.

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Reference:

Baker, J.E., Martin, G.E., Katsaros, G., Lewis, H.V., Wakefield, C.J., Josephs, S.A., Nomellini, V., Makley, A.T. and Goodman, M.D. (2018) Variability of fluid administration during exploratory laparotomy for abdominal trauma. Trauma Surgery & Acute Care Open. 3(1), p.e000240. eCollection 2018.

doi: 10.1136/tsaco-2018-000240.

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