ArticleBMC surgery2018
Crystalloid resuscitation in trauma patients: deleterious effect of 5L or more in the first 24h.
Article in BMC surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 48 citations in OpenAlex.
- Early versus delayed fixation of maxillofacial fractures in polytrauma: a systematic review.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Pooled it
- Guidelines for Enhanced Recovery After Trauma and Intensive Care (ERATIC): Enhanced Recovery After Surgery (ERAS) and International Association for Trauma Surgery and Intensive Care (IATSIC) Society Recommendations: Paper 2: Postoperative and Intensive Care Recommendations.World journal of surgery · 2025Guideline
- Prehospital Lyophilized Plasma Transfusion for Trauma-Induced Coagulopathy in Patients at Risk for Hemorrhagic Shock: A Randomized Clinical Trial.JAMA network open · 2022Trial
- The Importance of the "Damage Control" Strategy in Multiple Organ Injuries, Pathophysiology and Principles of Hemorrhage Control.Journal of clinical medicine · 2026Review
- Bimodal distribution of trauma-related acute kidney injury (TrAKI): A clinical review.Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) · 2026Review
- Cyclone-induced hematological emergencies: preparedness and response from a hematologist's viewpoint.Annals of medicine and surgery (2012) · 2025Review
- Predicting postoperative trauma-induced coagulopathy in patients with severe injuries by machine learning.Scientific reports · 2025Article
- Fresh whole blood: A feasible alternative in disasters and mass casualty incidents? a systematic review and meta-analysis.Conflict and health · 2024Review
- Advancements in Trauma-Induced Acute Kidney Injury: Diagnostic and Therapeutic Innovations.Life (Basel, Switzerland) · 2024Review
- Revolutionizing trauma care: advancing coagulation management and damage control anesthesia.Anesthesia and pain medicine · 2024Review
- ENGINEERED INTRAVENOUS THERAPIES FOR TRAUMA.Current opinion in biomedical engineering · 2023Article
- Traumatic hemorrhage and chain of survival.Scandinavian journal of trauma, resuscitation and emergency medicine · 2023Review
- Resuscitation with whole blood or blood components improves survival and lessens the pathophysiological burden of trauma and haemorrhagic shock in a pre-clinical porcine model.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023Article
- The need for an artificial oxygen carrier for disasters and pandemics, including COVID-19.Transfusion · 2020Article
- Damage Control Laparotomy: High-Volume Centers Display Similar Mortality Rates Despite Differences in Country Income Level.World journal of surgery · 2020Article
- Trauma Resuscitation for Interventional Radiologists.Seminars in interventional radiology · 2020Review
- Dilemma of crystalloid resuscitation in non-exsanguinating polytrauma: what is too much?Trauma surgery & acute care open · 2020Article
- Intraoperative Fluid Management in Patients Undergoing Spine Surgery: A Narrative Review.Frontiers in surgery · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOver-aggressive intravenous fluid therapy with crystalloids has adverse effects in trauma patients. We assessed the role of large-volume (≥5l) administration of crystalloids within 24h of injury as an independent risk-factor for mortality, in-hospital complications, and prolonged mechanical ventilation.
methodsA retrospective cohort analysis of adult trauma patients admitted to a level 1-trauma center between December 2011 and December 2012. Patient demographics, clinical and laboratory values, and total resuscitation fluid administered within the first 24h of injury were obtained. Outcomes included mortality, in-hospital complications and ventilator-days. Multivariable logistic regression and Poisson regression analyses were performed to investigate any association between the administration of ≥5L crystalloids with the aforementioned outcomes while controlling for selected clinical variables.
resultsA total of 970 patients were included in the analysis. 264 (27%) received ≥5L of crystalloids in the first 24h of injury. 118 (12%) had in-hospital complications and 337 (35%) required mechanical ventilation. The median age was 46 years (interquartile range (IQR) 27-65) years and 73% (n = 708) were males. The median injury severity score (ISS) was 17 (IQR 9-25). Overall mortality rate was 7% (n = 67). Multivariable logistic regression analysis showed several variables independently associated with mortality (p < 0.05), including resuscitation with ≥5L crystalloid in the first 24h (adjusted odds ratio (aOR) 2.55), older age (aOR 1.03), higher ISS (aOR 1.09), and lower temperature (aOR 0.68). The variables independently associated with in-hospital complications (p < 0.05) were older age, longer ICU stay, and platelet transfusion within 24h of the injury. Need for mechanical ventilation was more common in patients who received ≥5L crystalloids (RR 2.31) had higher ISS (RR 1.02), developed in-hospital complications (RR 1.91) and had lower presenting temperature (RR 0.87).
conclusionLarge-volume crystalloid resuscitation is associated with increased mortality and longer time ventilated, but not with in-hospital complications such as pneumonia and sepsis. Based on this data, we recommend judicious use of crystalloids in the resuscitation of trauma patients.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.