HEA: Possible pour les trauma ouverts

Differences between blunt and penetrating trauma after resuscitation with hydroxyethyl starch

Casey JA et Al. J Trauma Acute Care Surg. 2014;77: 859-864

----------------------------------------------------------------

Ce travail effectué avec un HEA ancien (450/07: Hetastarch^®, Hextent^®) suggère que l'emploi des HEA lors de la prise en charge de trauma ouvert n'est pas associé à un risque accru de décès ou d'insuffisance rénale. On rappelle qu'il ne s'agit pas de la même classe d'HEA que celle que nous avons l'habitude d'utiliser (130/0.4: Voluven)

----------------------------------------------------------------

BACKGROUND: The purpose of this study was to test the hypothesis that a single bolus of 6% hydroxyethyl starch (HES 450/0.7 in lactated electrolyte injection) during initial resuscitation has a differential effect in blunt and penetrating trauma patients.
METHODS: Consecutive admissions to the trauma service were reviewed. Patients who died within 24 hours were excluded. Multivariate analysis defined individual predictors for the primary outcomes, acute kidney injury (AKI) and mortality within 90 days. Data were expressed as mean T SD, and significance was assessed at p G 0.05.
RESULTS: Therewere 1,410 patients (76% male; mean T SD, age 43 T 18 years; 68% blunt trauma; mean T SD Injury Severity Score [ISS] 14 T 11; AKI, 4.4%; and mortality, 3.4%). HES (0.5-1.5 L) was administered to 216 patients (15.3%). After multiple logistic regression, HES remained a significant independent predictor of AKI after blunt trauma (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.24-5.19; area under the receiver operating characteristic curve [AUROC], 0.809) but not penetrating
trauma (OR, 0.90; 95% CI, 0.23-3.60; AUROC, 0.849). In separate logistic regression models, HES was a significant predictor of mortality after blunt trauma (OR, 3.77; 95% CI, 0.91-0.97; AUROC, 0.921) but not penetrating trauma (OR, 0.72; 95% CI, 0.13-3.94; AUROC, 0.904).

CONCLUSION: HES is an independent risk factor for AKI and death after blunt, but not penetrating, trauma, which underscores a fundamental difference between these two injury types.