Early aggressive use of fresh frozen plasma does not improve outcome in critically injured trauma patients.

OBJECTIVES: Recent data from Iraq supporting early aggressive use of fresh frozen plasma (FFP) in a 1:1 ratio to packed red blood cells (PRBCs) has led many civilian trauma centers to adopt this resource intensive strategy. METHODS: Prospective data were collected on 806 consecutive trauma patients admitted to the intensive care unit over 2 years. Patients were stratified by PRBC:FFP transfusion ratio over the first 24 hours. Stepwise regression models were performed controlling for age, gender, mechanism of injury, injury severity, and acute physiology and chronic health evaluation (APACHE) 2 score to determine if early aggressive use of PRBC:FFP improved outcome. RESULTS: Seventy-seven percent of patients were male (N = 617) and 85% sustained blunt injury (n = 680). Mean age, injury severity score (ISS), and APACHE score were 43 +/- 20 years, 29 +/- 13, and 13 +/- 7, respectively. Mean number of PRBCs and FFP transfused were 7.7 +/- 12 U, 6 U, and 5 +/- 12 U, respectively. Three hundred sixty-five (45%) patients were transfused in the first 24 hours. Sixty-eight percent (n = 250) of them received both PRBCs and FFP. Analyzing these patients by stepwise regression controlling for all significant variables, the PRBC:FFP ratio did not predict intensive care unit days, hospital days, or mortality even in patients who received massive transfusion (> or = 10 U). Furthermore, there was no significant difference in outcome when comparing patients who had a 1:1 PRBC:FFP ratio with those who did not receive any FFP. CONCLUSION: Early and aggressive use of FFP does not improve outcome after civilian injury. This may reflect inherent differences compared with military injury; however, this practice should be reevaluated.

Early hyperglycemic control is important in critically injured trauma patients.

BACKGROUND: Our objectives were to determine whether persistent hyperglycemia when compared with normoglycemia was predictive of outcome in the later stages of hospitalization in critically injured trauma patients. METHODS: A prospective study was conducted on 896 consecutive trauma patients admitted to the intensive care unit during a 2-year period. Patients were stratified by serum glucose level on day 1 to day 28 (low = 0-139 mg/dL, medium to high = 140-219 mg/dL, and high = >220 mg/dL), age, gender, race, insulin dependent diabetes, obesity, and Injury Severity Score (ISS). Patients were further stratified by pattern of glucose control (all low, all moderate, all high, improving, worsening, highly variable. Outcome was measured by ventilator days, infection, hospital and intensive care unit length of stay, and mortality. Multiple variable logistic and linear regression models were used to determine level of significance. RESULTS: Eighty-three percent were victims of blunt trauma. The majority (74%) were male, with a mean ISS of 26 +/- 12. Hyperglycemia (moderate, worsening, and highly variable) in the first week was associated with significantly greater hospital and intensive care unit length of stay, ventilator time, infection, and mortality when controlling for age, race, gender, ISS, mechanism of injury, obesity, and insulin dependent diabetes (p < 0.03). However, hyperglycemia in later weeks was not associated with infection and only weakly associated with mortality when analyzed by the same model. When controlling for glucose levels in subsequent weeks, patients who were normoglycemic in the first week had a lower infection rate and were less likely to die even when controlling for age, ISS, and obesity (p < 0.05). CONCLUSIONS: Early euglycemia is associated with improved outcome and appears to be protective regardless of glucose levels in subsequent weeks. Further studies are warranted to determine the etiology of this protective effect.