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90 Higher Initial Formula for Resuscitation After Severe Burn Injury Means Higher 24-Hour Volumes

INTRODUCTION: Initial fluid infusion rates for resuscitation of burn injuries typically use formulas based on patient weight and total body surface area (TBSA) burned. However, the impact of this rate on overall resuscitation volumes and outcomes have not been extensively studied. The purpose of thi...

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Autores principales: Rizzo, Julie, Coates, Elsa, Serio-Melvin, Maria, Aden, James, Stallings, Jonathan, Foster, Kevin, AbdelFattah, Kareem, Pham, Tam, Salinas, Jose
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10185147/
http://dx.doi.org/10.1093/jbcr/irad045.063
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author Rizzo, Julie
Coates, Elsa
Serio-Melvin, Maria
Aden, James
Stallings, Jonathan
Foster, Kevin
AbdelFattah, Kareem
Pham, Tam
Salinas, Jose
author_facet Rizzo, Julie
Coates, Elsa
Serio-Melvin, Maria
Aden, James
Stallings, Jonathan
Foster, Kevin
AbdelFattah, Kareem
Pham, Tam
Salinas, Jose
author_sort Rizzo, Julie
collection PubMed
description INTRODUCTION: Initial fluid infusion rates for resuscitation of burn injuries typically use formulas based on patient weight and total body surface area (TBSA) burned. However, the impact of this rate on overall resuscitation volumes and outcomes have not been extensively studied. The purpose of this study was to determine the impact of initial fluid rates on 24 hour volumes and outcomes using the Burn Navigator (BN). METHODS: The BN database is composed of 300 patients with > 20% TBSA, >40kg that were resuscitated utilizing the BN. Four study arms were analyzed based on the initial formula – 2ml/kg/TBSA, 3 ml/kg/TBSA, 4 ml/kg/TBSA or the Rule of Ten. Total fluids infused at 24 hours after admission were compared as well as resuscitation-related outcomes. RESULTS: A total of 296 patients were eligible for analysis. Higher starting rates (4 ml/kg/TBSA) resulted in significantly higher volumes at 24 hours (5.2 + 2.2 ml/kg/TBSA) than lower rates (2 ml/kg/TBSA resulted in 3.9 + 1.4 ml/kg/TBSA). No shock was observed in the high resuscitation cohort, whereas the lowest starting rate exhibited a 12% incidence, lower than both the Rule of Ten and 3 ml/kg/TBSA arms. There was no difference in 7-day mortality across groups. CONCLUSIONS: Higher initial fluid rates resulted in higher 24-hour fluid volumes. The choice of 2ml/kg/TBSA as initial rate did not result in increased mortality or more complications. An initial rate of 2ml/kg/TBSA is a safe strategy. APPLICABILITY OF RESEARCH TO PRACTICE: Utilizing a lower starting fluid rate is a safe strategy and should considered after severe burn injury.
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spelling pubmed-101851472023-05-16 90 Higher Initial Formula for Resuscitation After Severe Burn Injury Means Higher 24-Hour Volumes Rizzo, Julie Coates, Elsa Serio-Melvin, Maria Aden, James Stallings, Jonathan Foster, Kevin AbdelFattah, Kareem Pham, Tam Salinas, Jose J Burn Care Res C-256 Correlative XII: Clinical Sciences: Critical Care and Disaster Planning INTRODUCTION: Initial fluid infusion rates for resuscitation of burn injuries typically use formulas based on patient weight and total body surface area (TBSA) burned. However, the impact of this rate on overall resuscitation volumes and outcomes have not been extensively studied. The purpose of this study was to determine the impact of initial fluid rates on 24 hour volumes and outcomes using the Burn Navigator (BN). METHODS: The BN database is composed of 300 patients with > 20% TBSA, >40kg that were resuscitated utilizing the BN. Four study arms were analyzed based on the initial formula – 2ml/kg/TBSA, 3 ml/kg/TBSA, 4 ml/kg/TBSA or the Rule of Ten. Total fluids infused at 24 hours after admission were compared as well as resuscitation-related outcomes. RESULTS: A total of 296 patients were eligible for analysis. Higher starting rates (4 ml/kg/TBSA) resulted in significantly higher volumes at 24 hours (5.2 + 2.2 ml/kg/TBSA) than lower rates (2 ml/kg/TBSA resulted in 3.9 + 1.4 ml/kg/TBSA). No shock was observed in the high resuscitation cohort, whereas the lowest starting rate exhibited a 12% incidence, lower than both the Rule of Ten and 3 ml/kg/TBSA arms. There was no difference in 7-day mortality across groups. CONCLUSIONS: Higher initial fluid rates resulted in higher 24-hour fluid volumes. The choice of 2ml/kg/TBSA as initial rate did not result in increased mortality or more complications. An initial rate of 2ml/kg/TBSA is a safe strategy. APPLICABILITY OF RESEARCH TO PRACTICE: Utilizing a lower starting fluid rate is a safe strategy and should considered after severe burn injury. Oxford University Press 2023-05-15 /pmc/articles/PMC10185147/ http://dx.doi.org/10.1093/jbcr/irad045.063 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the American Burn Association. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle C-256 Correlative XII: Clinical Sciences: Critical Care and Disaster Planning
Rizzo, Julie
Coates, Elsa
Serio-Melvin, Maria
Aden, James
Stallings, Jonathan
Foster, Kevin
AbdelFattah, Kareem
Pham, Tam
Salinas, Jose
90 Higher Initial Formula for Resuscitation After Severe Burn Injury Means Higher 24-Hour Volumes
title 90 Higher Initial Formula for Resuscitation After Severe Burn Injury Means Higher 24-Hour Volumes
title_full 90 Higher Initial Formula for Resuscitation After Severe Burn Injury Means Higher 24-Hour Volumes
title_fullStr 90 Higher Initial Formula for Resuscitation After Severe Burn Injury Means Higher 24-Hour Volumes
title_full_unstemmed 90 Higher Initial Formula for Resuscitation After Severe Burn Injury Means Higher 24-Hour Volumes
title_short 90 Higher Initial Formula for Resuscitation After Severe Burn Injury Means Higher 24-Hour Volumes
title_sort 90 higher initial formula for resuscitation after severe burn injury means higher 24-hour volumes
topic C-256 Correlative XII: Clinical Sciences: Critical Care and Disaster Planning
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10185147/
http://dx.doi.org/10.1093/jbcr/irad045.063
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