{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T23:48:38Z","timestamp":1793836118118,"version":"4.6.1"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T00:00:00Z","timestamp":1673481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Appropriate fluid management is essential in the treatment of critically ill trauma patients. Both insufficient and excessive fluid volume can be associated with worse outcomes. Intensive fluid resuscitation is a crucial element of early resuscitation in trauma; however, excessive fluid infusion may lead to fluid accumulation and consequent complications such as pulmonary edema, cardiac failure, impaired bowel function, and delayed wound healing. The aim of this study was to examine the volumes of fluids infused in critically ill trauma patients during the first hours and days of treatment and their relationship to survival and outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively screened records of all consecutive patients admitted to the intensive care unit (ICU) from the beginning of 2019 to the end of 2020. All adults who were admitted to ICU after trauma and were hospitalized for a minimum of 2 days were included in the study. We used multivariate regression analysis models to assess a relationship between volume of infused fluid or fluid balance, age, ISS or APACHE II score, and mortality. We also compared volumes of fluids in survivors and non-survivors including additional analyses in subgroups depending on disease severity (ISS score, APACHE II score), blood loss, and age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 52 patients met the inclusion criteria for the study. The volume of infused fluids and fluid balance were positively correlated with mortality, complication rate, time on mechanical ventilation, length of stay in the ICU, INR, and APTT. Fluid volumes were significantly higher in non-survivors than in survivors at the end of the second day of ICU stay (2.77 vs. 2.14 ml\/kg\/h) and non-survivors had a highly positive fluid balance (6.21 compared with 2.48 L in survivors).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In critically ill trauma patients, worse outcomes were associated with higher volumes of infusion fluids and a more positive fluid balance. Although fluid resuscitation is lifesaving, especially in the first hours after trauma, fluid infusion should be limited to a necessary minimum to avoid fluid overload and its negative consequences.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.1040098","type":"journal-article","created":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T05:02:25Z","timestamp":1673499745000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["The volume of infusion fluids correlates with treatment outcomes in critically ill trauma patients"],"prefix":"10.3389","volume":"9","author":[{"given":"Anna","family":"Wrzosek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Drygalski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaros\u0142aw","family":"Garlicki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaros\u0142aw","family":"Woro\u0144","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Szpunar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Polak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakub","family":"Dro\u015b","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerzy","family":"Wordliczek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata","family":"Zaj\u0105czkowska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,1,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000219","article-title":"A higher fluid balance in the days after septic shock reversal is associated with increased mortality: an observational cohort study.","volume":"2","author":"van Mourik","year":"2020","journal-title":"Crit Care Explor."},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-020-00679-3","article-title":"Intravenous fluid therapy in the perioperative and critical care setting: executive summary of the International Fluid Academy (IFA).","volume":"10","author":"Malbrain","year":"2020","journal-title":"Ann Intensive Care."},{"key":"B3","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.kint.2018.11.047","article-title":"Fluid management in the critically ill.","volume":"96","author":"Vincent","year":"2019","journal-title":"Kidney Int."},{"key":"B4","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1097\/ACO.0b013e3283445326","article-title":"Fluid resuscitation in multiple trauma patients.","volume":"24","author":"Ertmer","year":"2011","journal-title":"Curr Opin Anaesthesiol."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-018-0402-x","article-title":"Principles of fluid management and stewardship in septic shock: it is time to consider the four D\u2019s and the four phases of fluid therapy.","volume":"8","author":"Malbrain","year":"2018","journal-title":"Ann Intensive Care."},{"key":"B6","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1213\/01.ANE.0000053256.77500.9D","article-title":"Hyperchloremic acidosis: the classic example of strong ion acidosis.","volume":"96","author":"Constable","year":"2003","journal-title":"Anesth Analg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"56","DOI":"10.5603\/AIT.2019.0011","article-title":"Thrombocytopenia: the most frequent haemostatic disorder in the ICU.","volume":"51","author":"Pluta","year":"2019","journal-title":"Anaesthesiol Intensive Ther."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1007\/s00268-006-0653-9","article-title":"Coagulopathy: its pathophysiology and treatment in the injured patient.","volume":"31","author":"Tieu","year":"2007","journal-title":"World J Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1007\/s12630-019-01480-y","article-title":"Restrictive fluid management strategies and outcomes in liver transplantation: a systematic review.","volume":"67","author":"Carrier","year":"2020","journal-title":"Can J Anaesth."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2253-14-62","article-title":"Liberal or restricted fluid administration: are we ready for a proposal of a restricted intraoperative approach?","volume":"14","author":"Della Rocca","year":"2014","journal-title":"BMC Anesthesiol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1007\/s00595-016-1393-6","article-title":"Liberal versus restrictive fluid management in abdominal surgery: a meta-analysis.","volume":"47","author":"Jia","year":"2017","journal-title":"Surg Today."},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012767.pub2","article-title":"Perioperative restrictive versus goal-directed fluid therapy for adults undergoing major non-cardiac surgery.","volume":"2019","author":"Wrzosek","year":"2019","journal-title":"Cochrane Database of Syst Rev."},{"key":"B13","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1097\/01.sla.0000143269.96649.3b","article-title":"Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: a randomized, double-blind study.","volume":"240","author":"Holte","year":"2004","journal-title":"Ann Surg."},{"key":"B14","doi-asserted-by":"publisher","first-page":"2263","DOI":"10.1056\/NEJMoa1801601","article-title":"Restrictive versus liberal fluid therapy for major abdominal surgery.","volume":"378","author":"Myles","year":"2018","journal-title":"N Engl J Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"S9","DOI":"10.1097\/TA.0b013e318290cd52","article-title":"Prehospital intravenous fluid is associated with increased survival in trauma patients.","volume":"75","author":"Hampton","year":"2013","journal-title":"J Trauma Acute Care Surg."},{"key":"B16","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1097\/TA.0b013e318208f99b","article-title":"Emergency department crystalloid resuscitation of 1.5 L or more is associated with increased mortality in elderly and nonelderly trauma patients.","volume":"70","author":"Ley","year":"2011","journal-title":"J Trauma Inj Infect Crit Care."},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1186\/1757-7241-20-13","article-title":"Prehospital trauma care reduces mortality. ten-year results from a time-cohort and trauma audit study in Iraq.","volume":"20","author":"Murad","year":"2012","journal-title":"Scand J Trauma Resusc Emerg Med."},{"key":"B18","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/00005373-197403000-00001","article-title":"The injury severity score: a method for describing patients. : journal of trauma and acute care surgery.","volume":"14","author":"Baker Susan","year":"1974","journal-title":"Trauma Injury Infect Crit Care."},{"key":"B19","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1097\/00003246-198510000-00009","article-title":"APACHE II: a severity of disease classification system.","volume":"13","author":"Knaus","year":"1985","journal-title":"Crit Care Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol."},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0224563","article-title":"Cumulative fluid balance predicts mortality and increases time on mechanical ventilation in ARDS patients: an observational cohort study.","volume":"14","author":"Van Mourik","year":"2019","journal-title":"PLoS One."},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3389\/fvets.2021.625708","article-title":"Fluid therapy and the microcirculation in health and critical illness.","volume":"8","author":"Es","year":"2021","journal-title":"Front Vet Sci."},{"key":"B23","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.1007\/s00134-022-06808-9","article-title":"How can assessing hemodynamics help to assess volume status?","volume":"48","author":"De Backer","year":"2022","journal-title":"Intensive Care Med."},{"key":"B24","doi-asserted-by":"crossref","first-page":"463","DOI":"10.5603\/CJ.a2020.0096","article-title":"Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: a systematic review and meta-analysis of randomized controlled trials.","volume":"29","author":"Safiejko","year":"2022","journal-title":"Cardiol J."},{"key":"B25","first-page":"1191","article-title":"Proper estimation of blood loss on scene of trauma: tool or tale?","volume":"69","author":"Frank","year":"2010","journal-title":"J Trauma."},{"key":"B26","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1016\/j.injury.2012.02.004","article-title":"Does increased prehospital replacement volume lead to a poor clinical course and an increased mortality? A matched-pair analysis of 1896 patients of the trauma registry of the german society for trauma surgery who were managed by an emergency doctor at th.","volume":"44","author":"Hussmann","year":"2013","journal-title":"Injury."},{"key":"B27","doi-asserted-by":"crossref","DOI":"10.1155\/2015\/354367","article-title":"Prehospital volume therapy as an independent risk factor after trauma.","volume":"2015","author":"Hussmann","year":"2015","journal-title":"Biomed Res Int."},{"key":"B28","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1007\/s00068-020-01423-z","article-title":"Changes in transfusion and fluid therapy practices in severely injured children: an analysis of 5118 children from the TraumaRegister DGU\u00ae.","volume":"48","author":"Piekarski","year":"2022","journal-title":"Eur J Trauma Emerg Surg."},{"key":"B29","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1177\/1457496915586650","article-title":"The effect of evolving fluid resuscitation on the outcome of severely injured patients: an 8-year experience at a tertiary trauma center.","volume":"105","author":"Brinck","year":"2016","journal-title":"Scand J Surg."},{"key":"B30","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1007\/s00134-013-2906-z","article-title":"Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the world society of the abdominal compartment syndrome. in: intensive care medicine.","volume":"39","author":"Kirkpatrick","year":"2013","journal-title":"Intensive Care Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1001\/archsurg.138.6.637","article-title":"Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome.","volume":"138","author":"Balogh","year":"2003","journal-title":"Arch Surg."},{"key":"B32","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/0010-4825(93)90092-F","article-title":"A computer model for analysis of fluid resuscitation.","volume":"23","author":"Barnea","year":"1993","journal-title":"Comput Biol Med."},{"key":"B33","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1007\/s13239-013-0169-z","article-title":"Optimization of oxygen delivery in fluid resuscitation for hemorrhagic shock: a computer simulation study.","volume":"5","author":"Siam","year":"2014","journal-title":"Cardiovasc Eng Technol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1007\/s13239-015-0237-7","article-title":"Blood flow versus hematocrit in optimization of oxygen transfer to tissue during fluid resuscitation.","volume":"6","author":"Siam","year":"2015","journal-title":"Cardiovasc Eng Technol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1250","DOI":"10.1007\/s11605-018-04089-6","article-title":"Restrictive versus liberal fluid regimens in patients undergoing pancreaticoduodenectomy: a systematic review and meta-analysis.","volume":"23","author":"Garland","year":"2019","journal-title":"J Gastrointest Surg."},{"key":"B36","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.jclinane.2016.07.010","article-title":"Liberal or restrictive fluid management during elective surgery: a systematic review and meta-analysis.","volume":"35","author":"Schol","year":"2016","journal-title":"J Clin Anesth."},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-06933-x","article-title":"Association between prehospital fluid resuscitation with crystalloids and outcome of trauma patients in Asia by a cross-national multicenter cohort study.","volume":"12","author":"Sung","year":"2022","journal-title":"Sci Rep."},{"key":"B38","doi-asserted-by":"publisher","first-page":"219","DOI":"10.2147\/IJNRD.S266864","article-title":"The impact of intravenous fluid therapy on acidbase status of critically ill adults: a stewart approach-based perspective.","volume":"13","author":"Kilic","year":"2020","journal-title":"Int J Nephrol Renovasc Dis."},{"key":"B39","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-015-0970-1","article-title":"A positive fluid balance is an independent prognostic factor in patients with sepsis.","volume":"19","author":"Acheampong","year":"2015","journal-title":"Crit Care."},{"key":"B40","doi-asserted-by":"crossref","DOI":"10.1186\/cc6916","article-title":"A positive fluid balance is associated with a worse outcome in patients with acute renal failure.","volume":"12","author":"Payen","year":"2008","journal-title":"Crit Care."},{"key":"B41","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1177\/0885066608329850","article-title":"Review of a large clinical series: association of cumulative fluid balance on outcome in acute lung injury: a retrospective review of the ARDSnet tidal volume study cohort.","volume":"24","author":"Rosenberg","year":"2009","journal-title":"J Intensive Care Med."},{"key":"B42","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1097\/01.CCM.0000194725.48928.3A","article-title":"Sepsis in European intensive care units: results of the SOAP study.","volume":"34","author":"Vincent","year":"2006","journal-title":"Crit Care Med."},{"key":"B43","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1097\/CCM.0000000000002255","article-title":"Surviving Sepsis campaign.","volume":"45","author":"Rhodes","year":"2017","journal-title":"Crit Care Med."},{"key":"B44","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1097\/SHK.0000000000000268","article-title":"Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death.","volume":"43","author":"Kelm","year":"2015","journal-title":"Shock."},{"key":"B45","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1097\/ALN.0b013e3181863117","article-title":"A rational approach to perioperative fluid management.","volume":"109","author":"Chappell","year":"2008","journal-title":"Anesthesiology."},{"key":"B46","doi-asserted-by":"publisher","first-page":"H1993","DOI":"10.1152\/ajpheart.00218.2005","article-title":"Atrial natriuretic peptide induces shedding of endothelial glycocalyx in coronary vascular bed of guinea pig hearts.","volume":"289","author":"Bruegger","year":"2005","journal-title":"Am J Physiol Heart Circ Physiol."},{"key":"B47","doi-asserted-by":"crossref","first-page":"54","DOI":"10.4037\/ccn2014133","article-title":"Trauma-induced coagulopathy.","volume":"34","author":"Katrancha","year":"2014","journal-title":"Crit Care Nurse."},{"key":"B48","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-020-02986-4","article-title":"Fluid removal associates with better outcomes in critically ill patients receiving continuous renal replacement therapy: a cohort study.","volume":"24","author":"Hall","year":"2020","journal-title":"Crit Care."},{"key":"B49","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1111\/1744-9987.13727","article-title":"Increased 28-day mortality due to fluid overload prior to continuous renal replacement in sepsis associated acute kidney injury.","volume":"26","author":"Fang","year":"2022","journal-title":"Ther Apher Dial."},{"key":"B50","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.jcrc.2021.04.017","article-title":"Timing of continuous renal replacement therapy in severe acute kidney injury patients with fluid overload: a retrospective cohort study.","volume":"64","author":"Lin","year":"2021","journal-title":"J Crit Care."},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-022-01528-6","article-title":"The injury severity score: an operations perspective.","volume":"22","author":"Dehouche","year":"2022","journal-title":"BMC Med Res Methodol."},{"key":"B52","doi-asserted-by":"crossref","DOI":"10.1186\/1757-7241-20-63","article-title":"Systematic review of predictive performance of injury severity scoring tools.","volume":"20","author":"Tohira","year":"2012","journal-title":"Scand J Trauma Resusc Emerg Med."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.1040098\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T05:02:36Z","timestamp":1673499756000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.1040098\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,12]]},"references-count":52,"alternative-id":["10.3389\/fmed.2022.1040098"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2022.1040098","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,12]]},"article-number":"1040098"}}