Intravenous Crystalloid Use in Trauma Victims after ICU Admission

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Introduction: Compared with blood products, guidelines for crystalloid (IVF) use in trauma are limited. We recently showed increased IVF given between ICU admission and lactate normalization was associated with worse outcomes; however, more IVF in the first 6 hours appeared beneficial. With updated data, we tested the hypothesis that early IVF is associated with improved outcomes. Methods: Linking our trauma registry with EHR data (2016-2019), we identified adults with initial lactate ≥4 mmol/L and subsequent normalization. We calculated time from ICU admission to lactate normalization, total IVF administered, and proportion of IVF given in the first 6 hours relative to the first 24 hours. We compared those receiving/not receiving >50% of their IVF in the first 6 hours on ICU days, ventilator days, AKI, and discharge disposition using both univariate methods and multivariable regression models to adjust for covariates. Results: 333 subjects were included. Median time to lactate normalization was 12 hours and total IVF was 2.2L, with 70% (IQR 40%, 100%) given in the first 6 hours of 24. Receiving >50% IVF in the first 6 hours was associated with fewer ICU days (beta1 -1.81, 95% CI [-3.48, -0.12]), lower risk of AKI (OR 0.41, 95% CI [0.24, 0.71]), and higher chance of home discharge (OR 1.87, 95% CI [1.02, 3.42]). Conclusion: As showed previously, IVF administration varies greatly. IVF timing is important, and early administration is associated with better outcomes. Guidelines for IVF resuscitation may improve outcomes through reduced variability and earlier IVF administration.

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