Effect of Fluid Resuscitation Strategy During En Route Care on Acute Lung Injury After Hemorrhage and Burn Injury
Technical Report,26 Feb 2016,25 Feb 2020
Air Force Expeditionary Medical Skills Institute Wright-Patterson AFB United States
Pagination or Media Count:
INTRODUCTION The epidemiology of casualties requiring Critical Care Air Transport Team CCATT evacuation has shifted to most of the patients suffering from multiple injuries. These injuries consist of injury of blast leading to critically ill patients suffering from total body surface area burns and high injury severity scores. This combination of injury patterns leads to unanswered questions and contradictions regarding resuscitation strategies for patients suffering hemorrhage and burn injury. As an example, the current clinical practice guideline CPG for resuscitation of burn injury recommends large volumes of crystalloid resuscitation while the CPG for damage control resuscitation recommends the aggressive use of blood products and fresh frozen plasma FFP. To further complicate resuscitation strategies in the hospital setting the predominating resuscitation strategy is the use of normal saline. These differences in CPGs and practice patterns are important to patient care, as crystalloid use is associated with worsened lung injury after trauma. Increased FFP use has been shown to be an independent risk factor in the development of lung injury in burn patients, but inadequate correction of coagulopathy with FFP in hemorrhage is associated with worsened mortality in CCATT patients. Our study focused on these inconsistencies with the intent to generate data to inform and guide decision making.
- Medicine and Medical Research