The changing pattern and implications of multiple organ failure after blunt injury with hemorrhagic shock Journal Article

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Authors: Minei, J. P.; Cuschieri, J.; Sperry, J.; Moore, E. E.; West, M. A.; Harbrecht, B. G.; O'Keefe, G. E.; Cohen, M. J.; Moldawer, L. L.; Tompkins, R. G.; Maier, R. V.; Gamelli, R. L.; Inflammation and the Host Response to Injury Collaborative Research Program.
Article Title: The changing pattern and implications of multiple organ failure after blunt injury with hemorrhagic shock
Abstract: OBJECTIVES: To describe the incidence of postinjury multiple organ failure and its relationship to nosocomial infection and mortality in trauma centers using evidence-based standard operating procedures. DESIGN: Prospective cohort study wherein standard operating procedures were developed and implemented to optimize postinjury care. SETTING: Seven U.S. level I trauma centers. PATIENTS: Severely injured patients (older than age 16 yrs) with a blunt mechanism, systolic hypotension (/=6 mEq/L), need for blood transfusion within the first 12 hrs, and an abbreviated injury score >/=2 excluding brain injury were eligible for inclusion. MEASUREMENTS AND MAIN RESULTS: One thousand two patients were enrolled and 916 met inclusion criteria. Daily markers of organ dysfunction were prospectively recorded for all patients while receiving intensive care. Overall, 29% of patients had multiple organ failure develop. Development of multiple organ failure was early (median time, 2 days), short-lived, and predicted an increased incidence of nosocomial infection, whereas persistence of multiple organ failure predicted mortality. However, surprisingly, nosocomial infection did not increase subsequent multiple organ failure and there was no evidence of a "second-hit"-induced late-onset multiple organ failure. CONCLUSIONS: Multiple organ failure remains common after severe injury. Contrary to current paradigms, the onset is only early, and not bimodal, nor is it associated with a "second-hit"-induced late onset. Multiple organ failure is associated with subsequent nosocomial infection and increased mortality. Standard operating procedure-driven interventions may be associated with a decrease in late multiple organ failure and morbidity.
Journal Title: Critical Care Medicine
Volume: 40
Issue: 4
ISSN: 1530-0293; 0090-3493
Publisher: Unknown  
Journal Place: United States
Date Published: 2012
Start Page: 1129
End Page: 1135
Language: eng
DOI/URL:

10.1097/CCM.0b013e3182376e9f

10.1097/CCM.0b013e3182376e9f
Notes: LR: 20130523; GR: T32 GM007035/GM/NIGMS NIH HHS/United States; GR: T32 GM007035-36/GM/NIGMS NIH HHS/United States; GR: U54 GM062119/GM/NIGMS NIH HHS/United States; GR: U54 GM062119-01A1/GM/NIGMS NIH HHS/United States; GR: U54 GM062119-02/GM/NIGMS NIH HHS/United States; GR: U54 GM062119-02S1/GM/NIGMS NIH HHS/United States; GR: U54 GM062119-03/GM/NIGMS NIH HHS/United States; GR: U54 GM062119-04/GM/NIGMS NIH HHS/United States; GR: U54 GM062119-05/GM/NIGMS NIH HHS/United States; GR: U54 GM062119-06/GM/NIGMS NIH HHS/United States; GR: U54 GM062119-07/GM/NIGMS NIH HHS/United States; GR: U54 GM062119-08/GM/NIGMS NIH HHS/United States; GR: U54 GM062119-09/GM/NIGMS NIH HHS/United States; GR: U54 GM062119-09S1/GM/NIGMS NIH HHS/United States; GR: U54 GM062119-10/GM/NIGMS NIH HHS/United States; GR: U54GM062119/GM/NIGMS NIH HHS/United States; GR: UL1 TR000064/TR/NCATS NIH HHS/United States; JID: 0355501; CIN: Crit Care Med. 2012 Apr;40(4):1348-9. PMID: 22425835; NIHMS331982; OID: NLM: NIHMS331982; OID: NLM: PMC3343366; ppublish