Effects of Perioperative Fluid Resuscitation on the Need for Renal Replacement Therapy in the Damage Control Laparotomy for Trauma

Abstract

Background

Minimizing crystalloid intravenous fluid (IVF) is a core tenet of damage control resuscitation strategies in trauma. However, there is a lingering notion that such fluid-restrictive strategies may cause acute kidney injury (AKI). We hypothesized that perioperative crystalloid administration volume was not associated with the need for renal replacement therapy (RRT) after damage control laparotomy (DCL).

Methods

A retrospective analysis was performed at an urban level 1 trauma center from 2019 to 2022. Risk factors for the need for RRT were evaluated using univariate and multiple logistic regression analyses.

Results

Among 279 included patients, most were male (77%), the median Injury Severity Score (ISS) was 25 (IQR: 17-34), and overall mortality was 7%. 30 (10.7%) received RRT. The volume of perioperative IVF given in the first 24 hours was 5.3 L for patients without RRT vs 7.3 L for patients who received RRT (P = 0.01). Both packed red blood cell (PRBC) transfusion (6 units vs 17 units, P < 0.0001) and ISS (24 vs 32, P < 0.0001) were also significantly different between groups. After multivariable logistic regression (MLR) adjustment, the need for RRT was associated only with ISS (AOR 1.05, 95% CI 1.01-1.08, P = 0.01) and PRBC transfusion volume in the first 24 hours (AOR 1.09, 95% CI 1.05-1.12, P < 0.0001).

Discussion

The need for RRT for critically injured patients undergoing DCL was not associated with perioperative crystalloid administration volume. Only injury severity markers and surrogates were independently associated with the need for RRT. Concern for AKI should not limit the use of contemporary damage control resuscitation strategies.