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Early High Volume Crystalloid Resuscitation Adversely Affects Pediatric Trauma Patients
Sophia Tam, MD, Barbara Coons, MD, Jeanne Rubsam, MS, Steven Stylianos, MD, Vincent Duron, MD. New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.

Background: Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. We hypothesize that early aggressive fluid resuscitation contributes to increased complications in pediatric trauma patients.

Methods: A retrospective review of trauma patients 0-18 years presenting from 1/2015 to 12/2015 to a Level 1 Pediatric Trauma Center was conducted. Age, gender, Glasgow Coma Score (GCS), and injury severity score (ISS) were documented. Dependent variables included number of days on the ventilator, days nil per os (NPO), bloodstream infections, surgical site infections, ICU length of stay (ICU LOS), overall length of stay (LOS), and mortality. Three patient cohorts were established based on volume of fluid administered: <40 ml/kg/day, 40-70 ml/kg/day, and >70 ml/kg/day, each measured over 24 hours and 48 hours after admission.

Results: 95 patients met inclusion criteria. 61% were male. 80% had ISS<9, 20% had ISS≥9. Fluid volume did not correlate with bloodstream infections, surgical site infections, or mortality. Fluid administered over the first 24 hours did not correlate with outcomes, nor did it over 48 hours if <70 ml/kg/day. However, volume of crystalloid >70ml/kg/day administered over the first 48 hours significantly correlated with number of days on the ventilator (P = 0.04), ICU LOS (P < 0.005), overall LOS (P < 0.005) and number of days NPO (P = 0.002).

Conclusions: Early administration of high volumes of crystalloid fluid greater than 70 ml/kg/day significantly correlates with pulmonary complications, days NPO, and hospital LOS in pediatric trauma patients.

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