7 Trend Analysis of Current Modalities for Monitoring Fluid Therapy in Patients with Large Burns: Echoing the Call for Better Resuscitation Indices

• Published in: Journal of burn care & research 2018-04, Vol.39 (suppl_1), p.S7-S8
• Main Authors: Liu, N T, Cancio, L C, Serio-Melvin, M L, Salinas, J
• Format: Article
• Language: English
• ISSN: 1559-047X; 1559-0488
• DOI: 10.1093/jbcr/iry006.011

Abstract Introduction Effective monitoring of fluid therapy remains a practical challenge in patients with large burns. Unfortunately, for these patients, there are not enough clinical studies demonstrating the efficacy of current modalities for monitoring resuscitation. Therefore, the aim of this study was to investigate whether current standards at our institution have effectively monitored resuscitations of severely burned patients during the first 48 hours post burn. Methods This retrospective study involved patients admitted to our burn intensive care unit from December 2007 to April 2013, with significant burns who required resuscitation using our computerized decision support system. Demographics, injuries as assessed by total body surface area and full thickness (TBSA, FT), and resuscitation volumes (lactated Ringer’s [LR]) were compared for all patients and those who died or survived. Means and standard deviations of hourly indices (urinary output [UOP], lactate [LAC], base excess [BE]) versus LR were analyzed. Waveforms, four-quadrant concordance, and correlation were also employed to compare the trending abilities (hourly change [∆]) of aforementioned variables versus LR. Results A total of 203 patients were included in the analysis. Of these, 71 (35%) died, and 50 (25%) had inhalation injuries. Mean age and weight were 47 ± 19 years and 87 ± 18 kg, respectively. Mean TBSA burned was 41 ± 20%, with a mean FT of 18 ± 24%. Age, TBSA, FT, and 24-hour/48-hour volumes were significantly lower in patients who survived than died (p>-1). This was confirmed by concordance plots, in which ∆UOP, ∆LAC×100, and ∆BE×10 versus ∆LR/10 yielded best-fit slopes of -6.261 (r=-0.2). 28.3 mL/mmol/L (r=0.7), and 2.1 mL/mmol/L (r=-0.2), respectively. Slopes in all groups demonstrated that UOP was a better resuscitative monitor than LAC or BE. For patients who died, ∆UOP versus ∆LR/10 yielded a slope of -17.537. For patients who survived, this slope was -1.769, showing that ∆UOP responded to ∆LR better in patients who survived than patients who died. Conclusions Reliance on hourly UOP as the sole index of optimal resuscitation is not supported. Current standards at our institution have not effectively monitored resuscitations on an hourly basis. This study echoed the call for better resuscitation indices