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Introduction: Administering large volumes of crystalloids to trauma patients has been shown to exacerbate metabolic complications of hemorrhage including dilutional coagulopathy and worsening acidosis The aim of this study was to evaluate crystalloid administration volumes in trauma patients after replacing 1 L IV containers with 500 mL IV containers in the emergency department trauma resuscitation bay.Materials and Methods: This was a single-center, IRB-approved, retrospective cohort evaluation of adult trauma patients conducted at an 864-bed community tertiary referral center located in the southeastern United States. Patterns of crystalloid administration were examined before and after the trauma resuscitation bay began to exclusively stock 500 mL IV containers. The primary outcome was mean total crystalloid volume infused from time of injury to hospital admission. Secondary outcomes included mean total crystalloid volume infused prior to administration of blood products, proportion of patients who received less than 2 L total of crystalloids, time to initiation of blood products, and mortality in both the emergency department and in-hospital.Results: Patient characteristics were largely similar between both groups including age, mechanism of injury, and Injury Severity Score. For the primary outcome, the mean total crystalloid volume infused from time of injury to hospital administration, patients in the 500 mL IV fluid container group were administered 555 mL less crystalloid when compared to the 1 L IV fluid container group, 1048 mL vs 1603 mL (p < 0.01; 95% CI 406 mL - 704 mL), respectively. After conversion to the 500 mL IV container bags, there was a 27.5% increase in the proportion of patients receiving less than 2 L of crystalloid, 90.5% vs 63.0% in the 500 mL IV fluid container and 1 L IV fluid container groups, respectively (p < 0.01).Conclusions: Due to reduced mortality, expanding literature and guidelines clearly support minimizing IV crystalloid resuscitation. Institutions must now work to minimize use of IV crystalloids to hemorrhaging trauma patients and a simple solution of using smaller IV fluid bags was shown to improve adherence to this practice. [ABSTRACT FROM AUTHOR]

Purpose: Moderate to severe acute respiratory distress syndrome (ARDS) is a complex disease with a high mortality rate. Prone positioning therapy is an effective treatment option that helps reduce mortality among patients with ARDS. Nurses are responsible for safe and effective patient positioning by either manually placing patients prone or using an automatic proning bed to do so. The purpose of this study was to analyze various outcomes associated with manual versus automatic prone positioning therapy in patients with ARDS. Background/Significance: Prior research on prone positioning therapy in ARDS has focused on mortality benefit, yet, to our knowledge, no study has compared the outcomes between manual and automatic prone positioning therapy. The multidisciplinary team of an 849-bed tertiary referral center implemented an evidencebased prone positioning protocol to guide the use of manual and automatic prone positioning therapy. Comparison of outcomes between the 2 groups will assist other institutions to make decisions about methods of pronation and implement protocols to promote safe practice. Method: After approval was received from the institutional review board, a retrospective, descriptive comparative approach was used to analyze data from 37 adult patients whose condition met the Berlin definition of moderate to severe ARDS. All patients received either manual or automatic prone positioning therapy between November 1, 2014, and November 30, 2016. Data were part of a quality improvement database initiated at the start of protocol implementation. Statistical analysis included χ² test for complications and discharge disposition, and Mann-Whitney U test for time to initiating prone positioning from physician order and for intensive care unit (ICU) and hospital length of stay (LOS). A cost analysis was used to evaluate the cost associated with each therapy. Results: Manual and automatic prone positioning therapies were used for 16 and 21 patients, respectively. Time to initiation was similar between groups. Patients undergoing automatic prone positioning therapy were more likely to experience pressure injuries (P = .04), especially of the head (P = .003), thorax (P = .003), and lower extremities (P = .047). Other complications did not differ significantly between groups. Although the difference was not statistically significant, patients placed prone manually had shorter ICU and hospital LOS (7.1 and 6.5 days, respectively) compared with patients undergoing automatic prone positioning. In addition, patients undergoing manual prone positioning therapy were more likely to be discharged home than were patients who had automatic prone positioning therapy (43.8% vs 28.6%). Conclusion: Owing to the small sample size, additional research is needed to determine if manual or automatic prone positioning therapy is preferred. However, these results suggest that manual prone positioning therapy is safer, has lower complication rates, and may be more efficacious, as indicated by decreased LOS and discharge disposition. When automatic prone positioning therapy is required (eg, morbid obesity limiting safe manual pronation), nursing interventions are important to protect the patient's skin from pressure injuries. [ABSTRACT FROM AUTHOR]