RT Journal
A1 Lucas CE, Ledgerwood AM
T1 Ffp:rBc resuscitation ratio and post-shock fluid uptake
JF JAMA Surgery
JO JAMA Surgery
YR 2013
FD March 1
VO 148
IS 3
SP 239
OP 244
DO 10.1001/jamasurg.2013.623
UL http://dx.doi.org/10.1001/jamasurg.2013.623
AB Objective 
                  To assess the effects of the fresh frozen plasma (FFP) to red
blood cell (RBC) ratio and balanced electrolyte solution (BES) to
RBC ratio during resuscitation of severely injured patients on the
duration of the postoperative fluid uptake period (phase 2) as well
as the fluid (BES) needs, weight gain, and hypoproteinemia in phase
2.Design, Setting, and Patients 
                  The 316 patients were hypotensive (systolic blood pressure = 81
mm Hg) and tachycardic (117/min), with an average shock time (systolic
blood pressure < 80 mm Hg) of 31 minutes in the operating
room (OR); they received 14.2 RBC units, 854 mL of FFP, and 11.5 L
of BES while in the OR. Phase 2 averaged 29.2 hours, where the patients
gained 8.4 kg, had a serum albumin level of 2.6 g per day, and received
8.6 L of BES. The phase 2 time, BES needs, weight gain, and hypoproteinemia
were correlated with systolic blood pressure, admission pulse rate,
arterial pH, shock time, RBC, FFP, and BES; the FFP:RBC, BES:RBC,
and BES:FFP ratios were given in the OR.Results 
                  Shock time had the best correlation with RBC, FFP, and BES administration
in the OR as well as with phase 2 duration, BES needs, weight gain,
and hypoproteinemia. There was no significant correlation with OR
FFP:RBC, BES:RBC, or BES:FFP ratios and phase 2 hypoproteinemia or
weight gain. The FFP:RBC ratio in the OR correlated directly with
phase 2 duration and BES needs (P = .001);
in contrast, the BES:RBC ratio in the OR correlated (P < .001) inversely with phase 2 duration and
BES needs.Conclusions 
                  The severity of shock is best predicted by shock time and the
RBC, FFP, and BES infusions in the OR. Contrary to recent reports,
the FFP:RBC ratio in the OR correlates directly with duration and
BES needs of phase 2, whereas the BES:RBC ratio correlates inversely
with phase 2 duration and BES needs.