82 Retrospective Review of Burn Resuscitation Outcomes Between 4 mL and 2 mL as a Starting Guide for Parkland Formula

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S53-S53
Author(s):  
Kyle R Rampetsreiter ◽  
Dhaval Bhavsar ◽  
Niaman Nazir
Keyword(s):  
Serum Creatinine ◽  
Urine Output ◽  
Burn Injury ◽  
Peak Serum ◽  
Mortality Data ◽  
Current Guideline ◽  
Thermal Burn ◽  
Starting Point ◽  
Burn Resuscitation ◽  
Parkland Formula

Abstract Introduction The ABA changed their fluid resuscitation guideline in 2011 for adult thermal burn injury patients from 4 mL to 2 mL per kilogram body mass per percent total body surface area (%TBSA) affected as a starting point for the Parkland formula. The primary aim of this change was to reduce the incidence of over resuscitation. We implemented this guideline at our institution in 2013. This retrospective analysis compares burn resuscitation outcomes prior to and post guideline change. Methods After approval from IRB, we collected data for all adult thermal burn injury patients with >20% TBSA from 2010 to 2012 for pre group and 2014–2016 for post group. Demographics, injury mechanisms, 24 and 48 hr resuscitation volume, 24 and 48 hr urine output, 24 hr peak serum creatinine, and mortality data was collected. Pre and post implementation groups were compared for 24 and 48 hr resuscitation volume, 24 and 48 hr urine output, 24 and 48 hr peak serum creatinine with t-test using SAS software. Mortality rates were compared too. Results The data is presented in table below. There was a significant reduction in total volume of resuscitation at 24 and 48 hr after implementation of the new guideline. There was also a significant reduction in the average 24 and 48 hr fluids used in the Parkland formula for the post group. This was achieved without significant reduction in urine output or increase in serum creatinine. Mean TBSA for pre and post groups were 36.2% and 33.1% respectively. There was no significant difference between extent of burn injury between these two groups.There was no significant change in mortality rate between the groups. Conclusions We observed lower volume of resuscitation for major thermal burn injury patients after implementation of the new guideline without adverse effect on renal function or outcomes. Applicability of Research to Practice The current guideline serves as a useful starting point for healthcare providers, allowing them to further resuscitate patients with additional fluids if needed. This change accomplishes optimal urine output and serum creatinine levels, while also providing better control of fluids to avoid over resuscitation.

scholarly journals A History of Fluid Management—From “One Size Fits All” to an Individualized Fluid Therapy in Burn Resuscitation

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 187
Author(s):  
Dorothee Boehm ◽  
Henrik Menke
Keyword(s):  
Fluid Therapy ◽  
Point Of Care ◽  
Fluid Management ◽  
Point Of Care Ultrasound ◽  
Burn Patients ◽  
Starting Point ◽  
History Of ◽  
Definition Of ◽  
Historical Developments ◽  
Burn Resuscitation

Fluid management is a cornerstone in the treatment of burns and, thus, many different formulas were tested for their ability to match the fluid requirements for an adequate resuscitation. Thereof, the Parkland-Baxter formula, first introduced in 1968, is still widely used since then. Though using nearly the same formula to start off, the definition of normovolemia and how to determine the volume status of burn patients has changed dramatically over years. In first instance, the invention of the transpulmonary thermodilution (TTD) enabled an early goal directed fluid therapy with acceptable invasiveness. Furthermore, the introduction of point of care ultrasound (POCUS) has triggered more individualized schemes of fluid therapy. This article explores the historical developments in the field of burn resuscitation, presenting different options to determine the fluid requirements without missing the red flags for hyper- or hypovolemia. Furthermore, the increasing rate of co-morbidities in burn patients calls for a more sophisticated fluid management adjusting the fluid therapy to the actual necessities very closely. Therefore, formulas might be used as a starting point, but further fluid therapy should be adjusted to the actual need of every single patient. Taking the developments in the field of individualized therapies in intensive care in general into account, fluid management in burn resuscitation will also be individualized in the near future.

scholarly journals Incidence of Acute Renal Failure in Full Term Neonates with Birth Asphyxia

2019 ◽  
Vol 4 (1) ◽  
pp. 671-674
Author(s):  
Chandra Bhushan Jha ◽  
Akhil Tamrakar
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Serum Creatinine ◽  
Renal Injury ◽  
Urine Output ◽  
Birth Asphyxia ◽  
Full Term ◽  
Acute Renal Injury ◽  
Term Neonates ◽  
Oliguric Renal Failure

Introduction: Birth asphyxia is an eventuality having far reaching consequences in the neonatal period. Hypoxia and ischemia can cause damage to almost every tissue and organ in the body and various target organs involved. Renal insult is a recognized complication of birth asphyxia and carries a poor prognosis. Timely detection of renal dysfunction and appropriate management may favorably alter the prognosis in many neonates with birth asphyxia. Objective: The present study was done to find out the incidence of acute renal failure in the full term neonates with birth asphyxia. Methodology: A cross sectional study was conducted at Birat Medical College Teaching Hospital, Morang, Nepal from 1st September 2017 to 28th February 2018. Fifty full term neonates born with Apgar score of <6 at 5 minutes and fulfilling inclusion criteria were enrolled in the study. Asphyxiated neonates having Serum creatinine >1.5gm/dl or urine output<1ml/kg/hr were labeled as cases of Acute Renal Failure. Blood sample for serum creatinine was collected at 24hrs, 48 hrs and 72 hrs of life. Results A total of 50 term asphyxiated neonates were enrolled in the present study. Among them 54% and 46% were males and females respectively with male to female ratio of 1.2:1. In the present study 62% of cases developed acute renal failure in either of the first three days of life with mean urine output 1.02±0.27ml/kg/hr and mean serum creatinine of 1.49±0.32 mg/dL. The incidence of oliguric renal failure was 52% and non oliguric renal failure was 48%.The association between serum creatinine and urine output was statistically significant. Conclusion: In the present study birth asphyxia has been an important cause of neonatal acute renal injury, revealing 31 (62%) cases. Monitoring urine output and serum creatinine has helped in detecting the asphyxiated neonates with acute renal injury in the early stage.

Delayed onset of acute renal failure after significant paracetamol overdose: A case series

2009 ◽  
Vol 29 (1) ◽  
pp. 63-68 ◽  
Author(s):  
WS Waring ◽  
H. Jamie ◽  
GE Leggett
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Serum Creatinine ◽  
Alanine Aminotransferase ◽  
Paracetamol Overdose ◽  
Peak Serum ◽  
Wilcoxon Test ◽  
Aminotransferase Activity ◽  
Baseline Serum ◽  
Alanine Aminotransferase Activity

Acute renal failure is a recognized manifestation of paracetamol toxicity, but comparatively little data is available concerning its onset and duration. The present study sought to characterize the time course of rising serum creatinine concentrations in paracetamol nephrotoxicity. Renal failure was defined by serum creatinine concentration ≥150 μmol/L (1.69 mg/dL) or ≥50% increase from baseline. Serum creatinine concentrations and alanine aminotransferase activity were considered with respect to the interval after paracetamol ingestion. There were 2068 patients with paracetamol overdose between March 2005 and October 2007, and paracetamol nephrotoxicity occurred in 8 (0.4%). All had significant hepatotoxicity, and peak serum alanine aminotransferase activity occurred at 2.5 days (2.2 to 2.9 days) after ingestion. Peak serum creatinine concentrations did not occur until 5.5 days (4.4 to 5.9 days) after ingestion (p = .031 by Wilcoxon test). Serum creatinine concentrations slowly restored to normal, and renal replacement was not required. In this patient series, rising serum creatinine concentrations only became detectable after more than 48 hours after paracetamol ingestion. Therefore, renal failure might easily be missed if patients are discharged home before this. Further work is required to establish the prevalence of paracetamol-induced nephrotoxicity, and its clinical significance.

scholarly journals Classifying AKI by Urine Output versus Serum Creatinine Level

2015 ◽  
Vol 26 (9) ◽  
pp. 2231-2238 ◽  
Author(s):  
John A. Kellum ◽  
Florentina E. Sileanu ◽  
Raghavan Murugan ◽  
Nicole Lucko ◽  
Andrew D. Shaw ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Urine Output

scholarly journals 978 Enhanced platelet-activating factor synthesis facilitates acute and delayed effects of intoxicated thermal burn injury

2018 ◽  
Vol 138 (5) ◽  
pp. S166
Author(s):  
E. Romer ◽  
R. Sahu ◽  
T. Smith ◽  
C.M. Rapp ◽  
C. Borchers ◽  
...  
Keyword(s):  
Burn Injury ◽  
Platelet Activating Factor ◽  
Thermal Burn ◽  
Delayed Effects

Dermal Nanoemulsion Treatment Reduces Burn Wound Conversion and Improves Skin Healing in a Porcine Model of Thermal Burn Injury

2021 ◽  
Author(s):  
Vladislav A Dolgachev ◽  
Susan Ciotti ◽  
Emma Liechty ◽  
Benjamin Levi ◽  
Stewart C Wang ◽  
...  
Keyword(s):  
Burn Injury ◽  
Hair Follicles ◽  
Silver Sulfadiazine ◽  
Histological Evaluation ◽  
Full Thickness ◽  
Burn Wound ◽  
Thermal Burn ◽  
Burn Wounds ◽  
Partial Thickness ◽  
Mediators Of Inflammation

Abstract Objective Burn wound progression is an inflammation driven process where an initial partial-thickness thermal burn wound can evolve over time to a full-thickness injury. We have developed an oil-in-water nanoemulsion formulation (NB-201) containing benzalkonium chloride for use in burn wounds that is antimicrobial and potentially inhibits burn wound progression. We used a porcine burn injury model to evaluate the effect of topical nanoemulsion treatment on burn wound conversion and healing. Methods Anesthetized swine received thermal burn wounds using a 25cm 2 surface area copper bar heated to 80 oC. Three different concentrations of NB-201 (10%, 20%, or 40% nanoemulsion), silver sulfadiazine cream or saline were applied to burned skin immediately after injury and on days 1, 2, 4, 7, 10, 14, and 18 post-injury. Digital images and skin biopsies were taken at each dressing change. Skin biopsy samples were stained for histological evaluation and graded. Skin tissue samples were also assayed for mediators of inflammation. Results Dermal treatment with NB-201 diminished thermal burn wound conversion to a full-thickness injury as determined by both histological and visual evaluation. Comparison of epithelial restoration on day 21 showed that 77.8% of the nanoemulsion treated wounds had an epidermal injury score of 0 compared to 16.7% of the silver sulfadiazine treated burns (p=0.01). Silver sulfadiazine cream and saline treated wounds (controls) converted to full-thickness burns by day 4. Histological evaluation revealed reduced inflammation and evidence of skin injury in NB-201 treated sites compared to control wounds. The nanoemulsion treated wounds often healed with complete regrowth of epithelium and no loss of hair follicles (NB-201: 4.8±2.1, saline: 0±0, silver sulfadiazine: 0±0 hair follicles per 4mm biopsy section, p&lt;0.05). Production of inflammatory mediators and sequestration of neutrophils were also inhibited by NB-201. Conclusions Topically applied NB-201 prevented the progression of a partial-thickness burn wound to full-thickness injury and was associated with a concurrent decrease in dermal inflammation.

Prognostic Factors in Neonatal Acute Renal Failure

PEDIATRICS ◽  
1984 ◽  
Vol 74 (2) ◽  
pp. 265-272
Author(s):  
Robert L. Chevalier ◽  
Fern Campbell ◽  
A. Norman A. G. Brenbridge
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Serum Creatinine ◽  
Perinatal Asphyxia ◽  
Urine Flow ◽  
Peak Serum ◽  
Serum Creatinine Concentration ◽  
Creatinine Concentration ◽  
Renal Anomalies ◽  
Renal Uptake

Sixteen infants, 2 to 35 days of age, had acute renal failure, a diagnosis based on serum creatinine concentrations &gt; 1.5 mg/dL for at least 24 hours. Eight infants were oliguric (urine flow &lt; 1.0 mL/kg/h) whereas the remainder were nonoliguric. To determine clinical parameters useful in prognosis, urine flow rate, duration of anuria, peak serum creatinine, urea (BUN) concentration, and nuclide uptake by scintigraphy were correlated with recovery. Nine infants had acute renal failure secondary to perinatal asphyxia, three had acute renal failure as a result of congenital cardiovascular disease, and four had major renal anomalies. Four oliguric patients died: three of renal failure and one of heart failure. All nonoliguric infants survived with mean follow-up serum creatinine concentration of 0.8 ± 0.5 (SD) mg/dL whereas that of oliguric survivors was 0.6 ± 0.3 mg/dL. Peak serum creatinine concentration did not differ between those patients who were dying and those recovering. All infants who were dying remained anuric at least four days and revealed no renal uptake of nuclide. Eleven survivors were anuric three days or less, and renal perfusion was detectable by scintigraphy in each case. However, the remaining survivor (with bilateral renal vein thrombosis) recovered after 15 days of anuria despite nonvisualization of kidneys by scintigraphy. In neonates with ischemic acute renal failure, lack of oliguria and the presence of identifiable renal uptake of nuclide suggest a favorable prognosis.

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