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

Joseph P. Minei, Joseph Cuschieri, Jason Sperry, Ernest E. Moore, Michael A. West, Brian G. Harbrecht, Grant E. O'Keefe, Mitchell J. Cohen, Lyle L. Moldawer, Ronald G. Tompkins, Ronald V. Maier

Research output: Contribution to journalArticle

83 Citations (Scopus)

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 (<90 mm Hg), and/or base deficit (≥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.

Original languageEnglish (US)
Pages (from-to)1129-1135
Number of pages7
JournalCritical Care Medicine
Volume40
Issue number4
DOIs
StatePublished - Apr 2012

Fingerprint

Nonpenetrating Wounds
Multiple Organ Failure
Hemorrhagic Shock
Cross Infection
Trauma Centers
Mortality
Incidence
Wounds and Injuries
Critical Care
Blood Transfusion
Hypotension
Brain Injuries
Cohort Studies
Prospective Studies
Morbidity

Keywords

  • infection
  • injury
  • mortality
  • multiple organ failure
  • standards of care
  • trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

The changing pattern and implications of multiple organ failure after blunt injury with hemorrhagic shock. / Minei, Joseph P.; Cuschieri, Joseph; Sperry, Jason; Moore, Ernest E.; West, Michael A.; Harbrecht, Brian G.; O'Keefe, Grant E.; Cohen, Mitchell J.; Moldawer, Lyle L.; Tompkins, Ronald G.; Maier, Ronald V.

In: Critical Care Medicine, Vol. 40, No. 4, 04.2012, p. 1129-1135.

Research output: Contribution to journalArticle

Minei, JP, Cuschieri, J, Sperry, J, Moore, EE, West, MA, Harbrecht, BG, O'Keefe, GE, Cohen, MJ, Moldawer, LL, Tompkins, RG & Maier, RV 2012, 'The changing pattern and implications of multiple organ failure after blunt injury with hemorrhagic shock', Critical Care Medicine, vol. 40, no. 4, pp. 1129-1135. https://doi.org/10.1097/CCM.0b013e3182376e9f
Minei, Joseph P. ; Cuschieri, Joseph ; Sperry, Jason ; Moore, Ernest E. ; West, Michael A. ; Harbrecht, Brian G. ; O'Keefe, Grant E. ; Cohen, Mitchell J. ; Moldawer, Lyle L. ; Tompkins, Ronald G. ; Maier, Ronald V. / The changing pattern and implications of multiple organ failure after blunt injury with hemorrhagic shock. In: Critical Care Medicine. 2012 ; Vol. 40, No. 4. pp. 1129-1135.
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AU - Harbrecht, Brian G.

AU - O'Keefe, Grant E.

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AB - 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 (<90 mm Hg), and/or base deficit (≥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.

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