705 Evaluation of Burn Resuscitation Practices at a Large Burn Center

Introduction Large burns cause a systemic inflammatory response in the entire body leading to profound capillary leak, tissue edema and hemodynamic instability, a condition known as burn shock. If not managed appropriately, the patient can go into cardiac collapse and multi-organ failure. Adequate and timely burn resuscitation is a cornerstone in burn care. Different formulas have been studied to estimate fluid needs during the first 24hrs. The purpose of this study was to retrospectively evaluate burn resuscitation practices of large burns (20% TBSA and greater) and their associated outcomes at a large urban burn center. Methods This was a retrospective chart review of adult patients admitted to the burn center with burns of 20% TBSA or greater who survived the first 48hrs of admission. Primary outcome was evaluating the percentage of patients who received resuscitation according to predetermined volume ranges (< or equal to 4ml/kg/% TBSA vs >4ml/kg/%TBSA). Secondary outcomes included the use of adjuncts (colloids and ascorbic acid), markers of over- and under-resuscitation, the use of perfusion markers to guide resuscitation, and ICU and hospital length of stay. Results One hundred and fifty one adults with burns of 30–50% TBSA were included. Fifty nine per cent of them received a median of 2.9ml/kg/%TBSA (low volume- LV group) compared to 41% that received 5.1ml/kg/%TBSA (high volume-HV group). The HV group received more adjuncts in form of colloids (73% vs 61%) and ascorbic acid infusion (55% vs 37% of patients). Majority of patients in both groups had an adequate urine output and showed an improved base deficit at 24hrs from admission which were used as resuscitation markers; lactate levels were trended infrequently. The most common over-resuscitation complication was pulmonary edema, found in both groups in ~ 30% of patients. Only 6% of patients in both groups required renal replacement therapy initiation at 96hrs from admission. Patients in the LV group had a shorter ICU and hospital length of stay (16 vs 36 days, and 27 vs 39 days, respectively, p value < 0.05). Conclusions Patients who received median resuscitation volumes of ~ 3ml/kg/%TBSA had better outcomes compared to patients who received higher volumes. Protocolized monitoring of resuscitation markers is key to tailoring resuscitation efforts to patient’s individual response. The effect of the different adjunct therapies (colloids, ascorbic acid) should be further investigated. Applicability of Research to Practice Burn resuscitation is a cornerstone of specialized critical burn care. Additional data regarding the amount and type of resuscitation volume used and its associated outcomes can advance practice to guide successful resuscitation and decrease early set backs that may further complicate the patient’s clinical course.