Differences between blunt and penetrating trauma after resuscitation with hydroxyethyl starch

Area of Science:

• Trauma resuscitation
• Nephrology
• Critical care medicine

Background:

• Initial resuscitation fluid choice is critical in trauma care.
• 6% hydroxyethyl starch (HES 450/0.7) is a commonly used fluid in trauma resuscitation.
• The differential impact of HES on blunt versus penetrating trauma requires investigation.

Purpose of the Study:

• To test the hypothesis that HES has a differential effect in blunt and penetrating trauma patients.
• To evaluate HES as a predictor of acute kidney injury (AKI) and mortality in trauma.
• To identify independent predictors for AKI and 90-day mortality.

Main Methods:

• Retrospective review of consecutive trauma admissions.
• Exclusion of patients deceased within 24 hours.
• Multivariate logistic regression analysis to determine predictors of AKI and mortality.

Main Results:

• HES administration (0.5-1.5 L) was associated with increased AKI risk in blunt trauma (OR, 2.54; 95% CI, 1.24-5.19).
• HES was also a significant predictor of mortality in blunt trauma (OR, 3.77; 95% CI, 0.91-0.97).
• No significant association was found between HES and AKI or mortality in penetrating trauma patients.

Conclusions:

• 6% hydroxyethyl starch (HES) is an independent risk factor for AKI and death following blunt trauma.
• HES does not appear to be a significant risk factor for AKI or death in penetrating trauma.
• This highlights a fundamental difference in the physiological response to blunt versus penetrating trauma.