[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
Article
September 1988

Early Fluid Requirements in Trauma PatientsA Predictor of Pulmonary Failure and Mortality

Author Affiliations

From the Department of Surgery, University of California, Davis, School of Medicine, Sacramento.

Arch Surg. 1988;123(9):1149-1157. doi:10.1001/archsurg.1988.01400330129020
Abstract

• The fluid required for initial resuscitation of trauma patients should reflect, at least in part, the severity of the original injuries and shock. We examined the hypothesis that the initial fluid requirements might also predict development of subsequent pulmonary failure and death. Fluid balances were calculated for the first 24 hours in the intensive care unit for 100 high-risk trauma patients. The mean (±1 SD) fluid balance for 63 patients who developed pulmonary failure was 4.6±5.5 L; the mean balances for the 37 patients who did not develop pulmonary failure were 1.0±3.1 L. The balances in 23 patients who died and in 77 who survived were 6.8±5.4 and 2.2±4.5 L, respectively. A cutoff value of 3 L determined prospectively before beginning the study predicted pulmonary failure with a sensitivity of 52% and a specificity of 89%. For mortality, the 3-L cutoff point gave a sensitivity of 74% and a specificity of 74%. The predictive value of the fluid balance was independent of other prognostic indicators, such as revised trauma scores, Injury Severity Scores, and modified APACHE II scores. This simple measurement should help in allocating intensive care unit resources, as patients in positive fluid balance are likely to require Swan-Ganz catheterization and are likely to require long-term mechanical ventilation. The fluid balance should also be useful in stratifying patients for entry into clinical trials.

(Arch Surg 1988;123:1149-1157)

References
1.
Sturm JA, Wisner DH, Oestern H-J, et al:  Increased lung capillary permeability after trauma: A prospective clinical study . J Trauma 1986;26:409-418.Article
2.
Cunningham JN Jr, Carter NW, Rector FC Jr, et al:  Resting transmembrane potential difference of skeletal muscle in normal subjects and severely ill patients . J Clin Invest 1971;50:49-59.Article
3.
Shires GT, Cunningham JN, Baker CRF, et al:  Alterations in cellular membrane function during hemorrhagic shock in primates . Ann Surg 1972;176:288-295.Article
4.
Committee on Trauma of the American College of Surgeons: Hospital and Prehospital Resources for Optimal Care of the Injured Patient . Chicago, American College of Surgeons, 1987.
5.
Baker SP, O'Neill B, Haddon W Jr, et al:  The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care . J Trauma 1974;14:187-196.Article
6.
Knaus WA, Draper EA, Wagner DP, et al:  APACHE II: A severity of disease classification . Crit Care Med 1985;13:818-829.Article
7.
Pepe PE, Potkin RT, Reus DH, et al:  Clinical predictors of the adult respiratory distress syndrome . Am J Surg 1982;144:124-130.Article
8.
McNeil BJ, Keeler E, Adelstein SJ:  Primer on certain elements of medical decision making . N Engl J Med 1975;293:211-215.Article
9.
Dixon WJ (ed): BMDP Statistical Software . Berkeley, Calif, University of California Press, 1983.
10.
Anous MM, Heimbach DM:  Causes of death and predictors in burned patients more than 60 years of age . J Trauma 1986;26:135-139.Article
11.
Carlson RG, Miller SF, Finley RK, et al:  Fluid retention and burn survival . J Trauma 1987;27:127-135.Article
12.
Rossignol AM, Burke JF:  A measure of the extent of burn injury based on fluid resuscitation . Burns 1982;9:89-98.Article
13.
Simmons RS, Berdine GG, Seidenfeld JJ, et al:  Fluid balance and the adult respiratory distress syndrome . Am Rev Respir Dis 1987;135:924-929.
14.
Knaus WA, Draper EA, Wagner DP, et al:  An evaluation of outcome from intensive care in major medical centers . Ann Intern Med 1986;104:410-418.Article
15.
Wagner DP, Knaus WA, Draper EA:  Physiologic abnormalities and outcome from acute disease: Evidence for a predictable relationship . Arch Intern Med 1986;146:1389-1396.Article
16.
Eiseman B, Ashbaugh DG:  Pulmonary effects of nonthoracic trauma: Introduction to conference . J Trauma 1968;8:649-650.Article
×