Change in resuscitation influenced development and severity of inflammatory complications in severely injured

Resuscitation strategies for severely injured patients have shifted toward reduced crystalloids and increased balanced blood product resuscitation, including Fresh Frozen Plasma (FFP) to reduce organ failure and mortality. However, FFP is associated with higher infection and sepsis risks. This study investigated the impact of resuscitation changes on inflammatory complications and mortality.

This 11-year cohort study included severely injured patients (> 15 years) admitted to a Level-1 Trauma Center ICU. Exclusions included isolated head injuries, drowning, asphyxiation, burns, and deaths < 48 h. Data on demographics, resuscitation, inflammatory complications (MODS, ARDS, infections, thromboembolism), and mortality were collected.

Among 585 patients (median age 46,72% male, ISS 29, 94% blunt injuries), 18% developed MODS, 3% ARDS, 45% infections, 9% thromboembolism, and 14% died. Over time, crystalloids ≤ 24 h decreased while FFP ≤ 24 h increased, correlating with reduced ARDS but increased thromboembolic events. Crystalloids ≤ 24 h independently predicted MODS, infections, and mortality, while FFP ≤ 24 h was linked to MODS and thromboembolism. Causes of death other than neurological included MODS (5%), sepsis (3%), and ARDS (1%), with no deaths from thromboembolic complications.

Resuscitation evolved toward less crystalloids and more FFP ≤ 24 h, likely reducing ARDS but increasing thromboembolic complications, while other outcomes remained comparable. Low mortality from inflammatory complications suggests these complications were mild. The anti-inflammatory, immune-modulating effect of FFP might have played a role in the attenuation of these complications, supporting current resuscitation strategies. However, improved identification of patients who require FFPs may help reduce thromboembolism. In the future, optimal FFP dosage should be determined to balance coagulopathy correction, blood volume restoration, and management of the inflammatory response following trauma.