Assessment of Volume and Fluid Resuscitation Strategies for Critically Ill Geriatric Trauma Patients: A Systematic Review.

IF 0.7 4区医学 Q4 CRITICAL CARE MEDICINE

Journal of Trauma Nursing Pub Date : 2025-05-20 DOI:10.1097/JTN.0000000000000861

Zackary Yates, Phillip Lee, Ruth Zagales, Caitlin Tweedie, Kirk Dourvetakis, Ariel Hus, Quratulain Amin, Logan Rogers, Adel Elkbuli

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引用次数: 0

Abstract

Objective: This study aims to evaluate fluid resuscitation strategies including volume assessment measures, conservative versus aggressive fluid resuscitation, and multifocal fluid resuscitation protocols in critically ill geriatric trauma patients.

Data sources: A comprehensive search was conducted across five databases including PubMed, Google Scholar, ProQuest, Embase, and Cochrane.

Study selection: Studies were included based on their relevance to volume assessment measures, conservative versus aggressive fluid resuscitation, and multifocal fluid resuscitation protocols in critically ill geriatric trauma patients.

Data extraction: A total of 14 studies met the inclusion criteria. Outcomes of interest included mortality, intensive care unit length of stay, ventilator days, and in-hospital complications.

Data synthesis: The initial query identified 1,257 studies, and after inclusion/exclusion criteria, a total of 14 studies were evaluated. On average, serum lactate levels above 2.5 mmol/L were found to be significantly associated with mortality. Conservative approaches to fluid resuscitation that were on average <1,500 cc were also found to decrease mortality and incur no increase in in-hospital complications. Additionally, goal-oriented geriatric fluid resuscitation protocols utilizing multiple measures for hemodynamic stability were found to reduce mortality in patients following the implementation of the protocol.

Conclusion: Serum lactate level kept on average below 2.5 mmol/L has shown to be an effective volume assessment measure and associated with decreased mortality. Additionally, conservative fluid resuscitation with volume maintained on average <15,000 cc was also associated with decreased mortality compared to aggressive fluid resuscitation measures. Lastly, goal-oriented geriatric fluid resuscitation protocols that aimed to maintain multiple volume assessment measures were associated with decreased mortality and complication rates. Implementation of these protocols has the potential to significantly improve outcomes in this vulnerable population.

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评估容量和液体复苏策略的危重症老年创伤患者：系统回顾。

目的：本研究旨在评估液体复苏策略，包括容量评估措施、保守与积极液体复苏以及多焦点液体复苏方案在危重老年创伤患者中的应用。数据来源：在PubMed、谷歌Scholar、ProQuest、Embase和Cochrane等5个数据库中进行了全面的搜索。研究选择：纳入的研究是基于它们与容量评估措施、保守与积极液体复苏的相关性，以及危重老年创伤患者的多焦点液体复苏方案。数据提取：共有14项研究符合纳入标准。研究结果包括死亡率、重症监护病房住院时间、呼吸机天数和院内并发症。数据综合：最初的查询确定了1257项研究，根据纳入/排除标准，总共评估了14项研究。平均而言，血清乳酸水平高于2.5 mmol/L与死亡率显著相关。结论：血清乳酸水平保持在2.5 mmol/L以下是一种有效的容积评估方法，可降低死亡率。保守性液体复苏，维持平均容量

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来源期刊

Journal of Trauma Nursing CRITICAL CARE MEDICINENURSING&-NURSING

CiteScore

1.20

自引率

10.00%

发文量

106

期刊介绍： Journal of Trauma Nursing (JTN) is the official journal of the Society of Trauma Nurses. The Society of Trauma Nurses believes that trauma is a disease impacting patients through the continuum of care. The mission of STN is to ensure optimal trauma care through education, collaboration, leadership and membership engagement. As the official publication of the Society of Trauma Nurses, the Journal of Trauma Nursing supports the STN’s strategic goals of effective communication, education and patient advocacy with original, peer-reviewed, research and evidence-based articles and information that reflect the highest standard of collaborative care for trauma patients. The Journal of Trauma Nursing, through a commitment to editorial excellence, implements STN’s vision to improve practice and patient outcomes and to become the premiere global nursing organization across the trauma continuum.