A New Resuscitation Formula Based on Burn Index Provides More Reliable Prediction for Fluid Requirement in Adult Major Burn Patients

Abstract The Third Military Medical University (TMMU) formula is widely used in fluid resuscitation in China. However, the actual volume needs usually exceed the prediction provided by the TMMU formula in major burn patients with a high proportion of full-thickness burn wounds. This retrospective study included 149 adult major burn patients (≥40% TBSA) who were admitted to the Burn Department, Southwest Hospital from 2014 to 2020 and received appropriate fluid resuscitation by the TMMU protocol. The actual volume infused in the first 48 hours postburn was compared to the estimation by the TMMU formula. A new fluid volume prediction formula was developed by multivariate linear regression analysis. The mean fluid requirements were 2.35 ml/kg/% TBSA and 1.75 ml/kg/% TBSA in the first and second 24 hours postburn, respectively. The TMMU formula underestimated the fluid requirement, and its prediction accuracy was 54.1% and 25.8% for the first and second 24 hours, respectively. The proportion of full-thickness burn wound was found to be associated with the fluid requirements postburn. A revised multifactorial formula consisting of the burn index, body weight, and inhalation injury was developed. Using the revised formula, the prediction reliability of resuscitation fluid volume improved to 65.3% and 61.1% in the first and second 24 hours, respectively. The TMMU formula showed low accuracy in predicting fluid requirements among major burn patients. A revised formula based on burn index was developed to provide better guidance for initiative fluid resuscitation for major burns by the TMMU protocol.

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Goal-Directed Fluid Resuscitation Protocol Based on Arterial Waveform Analysis of Major Burn Patients in a Mass Burn Casualty

Annals of Plastic Surgery ◽

10.1097/sap.0000000000001288 ◽

2018 ◽

Vol 80 ◽

pp. S21-S25

Author(s):

Hao-Yu Chiao ◽

Chang-Yi Chou ◽

Yuan-Sheng Tzeng ◽

Chih-Hsin Wang ◽

Shyi-Gen Chen ◽

...

Keyword(s):

Fluid Resuscitation ◽

Waveform Analysis ◽

Burn Patients ◽

Arterial Waveform ◽

Major Burn ◽

Arterial Waveform Analysis

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Molecular identification and genotyping of Acinetobacter baumannii isolated from burn patients by PCR and ERIC-PCR

Scars Burns & Healing ◽

10.1177/2059513119831369 ◽

2019 ◽

Vol 5 ◽

pp. 205951311983136 ◽

Cited By ~ 3

Author(s):

Faezeh Falah ◽

Leili Shokoohizadeh ◽

Maryam Adabi

Keyword(s):

Acinetobacter Baumannii ◽

Epidemiological Studies ◽

Burn Patients ◽

Chain Reaction ◽

Burn Wound ◽

Accurate Identification ◽

Microbiological Test ◽

Major Burn ◽

Screening And Identification ◽

Polymerase Chain

Background: Acinetobacter baumannii is one of the most important agents of hospital infections. Rapid and accurate identification and genotyping of A. baumannii is very important, especially in burn hospitals in order to prevent the spread of related nosocomial infections and to further epidemiological studies. Material and methods: For two months, 82 A. baumannii isolates were collected from burn wound swabs of patients in a major burn hospital in Tehran. A. baumannii isolates were identified by conventional microbiological test and polymerase chain reaction (PCR) using the primers of blaOXA-51 gene, while the genetic linkage of A. baumannii isolates was investigated by enterobacterial repetitive intragenic consensus (ERIC)-PCR technique. Similarity, a cut-off of ⩾ 95% was considered for classifying the genotypes. Results: The molecular test (PCR) confirmed 97.56% of phenotypic results for the detection of A. baumannii isolates. ERIC-PCR results revealed 14 different ERIC patterns (ERIC-types) including 11 common types and three unique types. Conclusion: Our findings show that we can simply and quickly detect A. baumannii isolates by PCR using blaOXA genes and genetic diversity by ERIC-PCR, respectively. These rapid and simple techniques for the routine screening and identification of clinical A. baumannii isolates could be useful with epidemic potential.

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Fluid resuscitation for major burn patients with the TMMU protocol

Burns ◽

10.1016/j.burns.2009.02.020 ◽

2009 ◽

Vol 35 (8) ◽

pp. 1118-1123 ◽

Cited By ~ 14

Author(s):

Gaoxing Luo ◽

Yizhi Peng ◽

Zhiqiang Yuan ◽

Wenguang Cheng ◽

Jun Wu ◽

...

Keyword(s):

Fluid Resuscitation ◽

Burn Patients ◽

Major Burn

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Correlation of Hypernatremia to Success Rate of Skin Graft in Burn Patients Dr. Soetomo Hospital Burn Centre from 2014- 2018

Jurnal Rekonstruksi dan Estetik ◽

10.20473/jre.v4i2.28218 ◽

2021 ◽

Vol 4 (2) ◽

pp. 44

Author(s):

Ephora Wulandari ◽

Lynda Hariani ◽

Agus Santoso Budi

Keyword(s):

Relative Risk ◽

Skin Graft ◽

Healing Process ◽

Electrolyte Imbalance ◽

Split Thickness Skin Graft ◽

Wound Healing Process ◽

Chemical Agent ◽

Burn Patients ◽

Burn Wound ◽

Major Burn

Background : From collective data from 2014 – 2018 from Burn Centre in Dr. Soetomo Hospital, the rate of failed skin graft was 26%. This high number became a concerned because skin graft was the main procedure to close large burn wound. This event is affected by many problems, one of them is electrolyte imbalance. Hypernatremia was seen in major burn patients that causes the disruption of wound healing process of skin graft. Methods: A cross sectional study of patients with burns admitted to the Burn Centre of Dr. Soetomo Hospital between January 2014 and December 2018 were evaluated. Results : 143 subjects were involved in this study. 44 subjects are female (31%) and 99 subjects are male (69%). 66% of the burn injuries are caused by fire (93 subjects), 14% caused by electricity (20 subjects), 8% caused by scald (12 subjects), 6% caused by boiled oil (8 subjects), 4% caused by chemical agent (6 subjects) and 2% caused by blast injury (1 subject). 77% of all subjects (110 subjects) underwent split thickness skin graft less than 10% while 23% (33 subjects) underwent the procedure 10% or more than it. Hypernatremia is found in 16% of all subjects (23 subjects), 19% with hyponatremia (28 subjects) and majority of it, 65%, with normonatremia (92 subjects). From the study, it was found that the risk of failed skin graft was higher on hypernatremia subjects than normonatremia subjects, the relative risk was 6,06 to fail. This number was higher if the skin graft procedure took more than 10%. But, it was found the risk was higher on hyponatremia subjects than the rest of subjects, with the relative risk was 7,75 to fail. Conclusions: Hypernatremia caused high risk of failed skin graft on major burn patients

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Fluid management in major burn injuries

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699459 ◽

2010 ◽

Vol 43 (S 01) ◽

pp. S29-S36

Author(s):

Mehmet Haberal ◽

A. Ebru Sakallioglu Abali ◽

Hamdi Karakayali

Keyword(s):

Patient Group ◽

Fluid Resuscitation ◽

Fluid Management ◽

Burn Injuries ◽

Fluid Loss ◽

Burn Patients ◽

Burn Treatment ◽

Major Burn ◽

The World ◽

The Status

ABSTRACTIt is a widely accepted fact that severe fluid loss is the greatest problem faced following major burn injuries. Therefore, effective fluid resuscitation is one of the cornerstones of modern burn treatment. The aim of this article is to review the current approaches available for modern trends in fluid management for major burn patients. As these current approaches are based on various experiences all over the world, the knowledge is essential to improve the status of this patient group.

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Application of DSM-BIA in dry weight assessment in continuous ambulatory peritoneal dialysis

10.21203/rs.3.rs-770259/v1 ◽

2021 ◽

Author(s):

Qi Chen ◽

Zheng Wang ◽

Na Liu ◽

Shujuan Mu ◽

Peng Guo ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Linear Regression ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Linear Regression Analysis ◽

Fluid Management ◽

Intraclass Correlation ◽

Dry Weight ◽

Fluid Volume ◽

Multivariate Linear Regression ◽

Multivariate Linear Regression Analysis

Abstract ObjectivesDry weight assessment (DWA) is an important part of dialysis and fluid management in patients receiving renal replacement therapy. With the development of bioimpedance analysis (BIA), the development of the direct segmental multi-frequency BIA (DSM-BIA) has provided a more convenient measure for DWA of dialysis patients, but its accuracy remains unclear. This study was designed to evaluate the application of DSM-BIA in DWA of continuous ambulatory peritoneal dialysis (CAPD) patients.DesignThis is a cross-sectional study. Using the conventional BIA as a reference, we examined the accuracy of the DSM-BIA technique for assessing dry weight in CAPD patients and analyzed the potential factors influencing their fluid volume status.Setting and Participants:A total of 31 patients with end-stage renal disease receiving CAPD and 310 healthy volunteers were recruited for this study.MethodsThe intraclass correlation coefficients (ICC) and Bland-Altman plots were used to assess the consistency between DSM-BIA and the conventional BIA for DWA. Univariate and multivariate linear regression analyses were used to explore the influencing factors associated with the edema index.ResultsDSM-BIA and the conventional BIA technology were consistent in DWA in CAPD patients (ICC female 0.972, ICC male 0.882, ICC total 0.960). Similarly, Bland-Altman plots showed good agreements between the two methods in DWA for both genders. Univariate and multivariate linear regression analysis showed both eGFR level (P = 0.04) and serum NT-pro BNP concentration (P = 0.007) were positively correlated with the ratio of extracellular water to total body water (ECW/TCW).ConclusionsDSM-BIA in DWA has good accuracy in clinical applications and has potential application value for fluid volume management in CAPD patients.

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Elevated Intraocular Pressure in Burn Patients Undergoing Fluid Resuscitation: An Opportunity to Avoid Orbital Compartment Syndrome

Journal of Academic Ophthalmology ◽

10.1055/s-0040-1713146 ◽

2020 ◽

Vol 12 (02) ◽

pp. e87-e91

Author(s):

Christine Y. Shen ◽

Spencer Woody ◽

Spencer D. Fuller ◽

Landon K. Grange ◽

Kimberly D. Tran ◽

...

Keyword(s):

Intraocular Pressure ◽

Compartment Syndrome ◽

Fluid Resuscitation ◽

San Diego ◽

Fluid Volume ◽

Treatment Recommendation ◽

Burn Patients ◽

Resuscitation Guidelines ◽

Elevated Intraocular Pressure ◽

Total Fluid

Abstract Objective This study aims to discuss clinical characteristics of burn patients who developed elevated intraocular pressure (IOP). We propose management strategies to prevent orbital compartment syndrome before invasive treatment is required. Methods A retrospective review of 47 burn patients at the University of California San Diego (UCSD), Burn Intensive Care Unit (ICU; major regional burn center for San Diego county), was analyzed for demographics, fluid resuscitation volumes, and physical exam findings. Patients requiring topical treatment for high-IOP, defined as ≥30 mm Hg in either or both eyes, were compared with those who did not require treatment, using the t-test and Fisher's exact test. Linear regression tested for an association between peak IOP and fluid volume. Logistic regression evaluated the association between total fluid and treatment of high IOP, while adjusting for other characteristics. Results Six of 47 patients required IOP-lowering treatment. Of the patients requiring treatment, one drop of dorzolamide/timolol in both eyes twice daily was the most common treatment recommendation. Presence of periocular burns was a significant risk factor in patients who required treatment for high IOP. No patients developed orbital compartment syndrome or required surgical intervention to lower IOP. The mean total fluid volume delivered in the first 24 hours was 0.8 times the level prescribed by fluid resuscitation guidelines. Conclusion By treating early clinical signs and properly managing fluid resuscitation, development of orbital compartment syndrome in burn patients can be avoided.

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Nudegusių ligonių ir jų žaizdų patogenų analizė

Lietuvos chirurgija ◽

10.15388/lietchirur.2004.3.2358 ◽

2004 ◽

Vol 2 (3) ◽

pp. 0-0 ◽

Cited By ~ 2

Author(s):

Rokas Bagdonas ◽

Algimantas Tamelis ◽

Rytis Rimdeika ◽

Mindaugas Kiudelis

Keyword(s):

Staphylococcus Aureus ◽

Burn Injury ◽

Young Male ◽

Microbiological Analysis ◽

Burn Patients ◽

Burn Wound ◽

Burn Wounds ◽

Major Burn ◽

A Minor ◽

Age Range

Rokas Bagdonas, Algimantas Tamelis, Rytis Rimdeika, Mindaugas Kiudelis Įvadas / tikslas Didžiausia nudegimų chirurgijos problema yra infekcija, nuo kurios miršta daugiau kaip 50% visų nudegusių pacientų. Nudegimų žaizda greitai infekuojasi, kadangi žaizdos aplinka yra ideali mikroorganizmams atsirasti ir daugintis. Studijoje, patvirtintoje Universiteto etikos komiteto, analizuojami nudegę pacientai ir iš nudegimo žaizdų išskirti patogenai. Pacientai ir metodai Mes analizavome 2246 nudegusius pacientus (amžiaus vidurkis – 27 metai), gydytus KMU Chirurgijos klinikose 1997–2002 metais. Nudegimo sunkumas buvo vertintas pagal Amerikos nudegimų asociacijos (ABA) schemą. 2462 nudegimo žaizdos pasėliai (2246 pacientų) buvo paimti steriliu tamponu ir pasėti 5% kraujo ir MacConkey terpėse. Rezultatai Iš nudegusių pacientų 1447 (74%) buvo vyrai ir 799 (26%) – moterys (p < 0,001). Pacientų amžius – nuo 2 iki 47 metų. 1261 (56%, p < 0,05) pacientai patyrė lengvą, 522 – vidutinį ir 463 – sunkų kūno nudegimą. 2130 pasėliai (86,5%), paimti iš 2462 nudegimo žaizdų, buvo teigiami. Iš 2130 teigiamų pasėlių Staphylococcus aureus išskirtas 1110 (52,1%) pasėliuose, iš jų MRSA – 498 (23,4%). Išvados Jauni vyrai dažniausiai patiria lengvus kūno nudegimus. Nudegimo žaizda dažniausiai infekuojasi S. aureus mikroorganizmais. MRSA yra pagrindinis ligoninės patogenas, infekuojantis nudegimo žaizdą. Prasminiai žodžiai: nudegimo sunkumas, nudegimo žaizdos patogenai, išskirti sukėlėjai Analysis of burn patients and the isolated pathogens Rokas Bagdonas, Algimantas Tamelis, Rytis Rimdeika, Mindaugas KiudelisKaunas Medical University, Clinic of Surgery,Eivenių str. 2, LT-50009, Kaunas, LithuaniaE-mail: [email protected] Background / objective The major challenge for a burn team is infection, which is known to cause over 50% of burn deaths. Burns become infected, because the environment at the site of the wound is ideal for the proliferation of infecting organisms. This study, approved by the regional Ethics Committee, analyzes the features of burned patients and the rates of pathogens isolated from burn wounds. Patients and methods We studied 2246 burn patients (mean age 27 years) admitted to the tertiary academic hospital in 1997–2002. The differentiation of the severity of burn injury was based on the scheme of the American Burn Association (ABA). 2462 surface swabs for microbiological analysis were taken from all 2246 patients. The wound area was swabbed with an alginate swab and cultured in 5% blood and MacConkey agar. Results There were 1447 (74%) men and 799 (26%) women (p < 0.001), age range 2–47 years. There were 1261 patients (56%, p < 0.05) with minor, 522 with moderate and 463 with major burn injuries. 2130 swabs (86.5%) out of 2462 burn wound surface swabs were positive. Out of 2130 isolates positive for pathogenic bacterial culture, there were 1110 (52.1%) isolates positive for Staphylococcus aureus infection. The rate of MRSA was 23.4% (498 isolates). Conclusions Young male patients mostly have a minor burn injury. Burn wounds are most commonly infected with S. aureus. MRSA is still the main hospital pathogen in burns. Keywords: severity of the burn injury, burn swabs, isolated pathogens

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