Nebulized Heparin With N-Acetylcysteine and Albuterol Reduces Duration of Mechanical Ventilation in Patients With Inhalation Injury

2017 ◽  
Vol 32 (2) ◽  
pp. 163-166 ◽  
Author(s):  
Kaitlin A. McGinn ◽  
Katie Weigartz ◽  
Alicia Lintner ◽  
Michael J. Scalese ◽  
Steven A. Kahn
Keyword(s):  
Mechanical Ventilation ◽  
Unit Length ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Inclusion Criteria ◽  
Mechanically Ventilated ◽  
Total Body ◽  
Injury Outcomes ◽  
The Impact

Objective: Nebulized heparin has been proposed to improve pulmonary function in patients with inhalation injuries. The purpose of this study was to evaluate the impact of nebulized heparin with N-acetylcysteine (NAC) and albuterol on the duration of mechanical ventilation in burn patients. Methods: This is a retrospective study evaluating mechanically ventilated adult patients admitted to a regional burn center with inhalation injury. Outcomes were compared between patients who were prescribed a combination of nebulized heparin with NAC and albuterol versus similar patients who did not. Results: A total of 48 patients met inclusion criteria (heparin n = 22; nonheparin n = 26). Patients in the nonheparin group had higher percentage of total body surface area (TBSA) burned (29.00 [5.75-51.88] vs 5.25 [0.50-13.25] %TBSA; P = .009), longer duration of mechanical ventilation (6.50 [2.75-17.00] vs 3.00 [1.00-8.25] days; P = .022), and longer intensive care unit length of stay (LOS) (3.00 [3.00-28.75] vs 5.50 days [2.00-11.25]; P = .033). Upon regression, use of heparin was the only variable associated with reducing the duration of mechanical ventilation ( P = .039). Conclusion: Nebulized heparin in combination with NAC and albuterol was associated with a significant reduction in the duration of mechanical ventilation.

11 Vitamin D Deficiency on Admission and the Association with Length of Stay in Patients with Thermal Injury: A Multi-center Analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S13-S14
Author(s):  
Sarah Zavala ◽  
Kate Pape ◽  
Todd A Walroth ◽  
Melissa A Reger ◽  
Katelyn Garner ◽  
...  
Keyword(s):  
Vitamin D ◽  
Length Of Stay ◽  
Vitamin D Deficiency ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Comfort Care ◽  
The Impact

Abstract Introduction In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). Methods This was a multi-center retrospective study of adult patients at 7 burn centers admitted between January 1, 2016 and July 25, 2019 who had a 25-hydroxyvitamin D (25OHD) concentration drawn within the first 7 days of injury. Patients were excluded if admitted for a non-burn injury, total body surface area (TBSA) burn less than 5%, pregnant, incarcerated, or made comfort care or expired within 48 hours of admission. The primary endpoint was to compare hospital LOS between burn patients with vitamin D deficiency (defined as 25OHD < 20 ng/mL) and sufficiency (25OHD ≥ 20 ng/mL). Secondary endpoints include in-hospital mortality, ventilator-free days of the first 28, renal replacement therapy (RRT), length of ICU stay, and days requiring vasopressors. Additional data collected included demographics, Charlson Comorbidity Index, injury characteristics, form of vitamin D received (ergocalciferol or cholecalciferol) and dosing during admission, timing of vitamin D initiation, and form of nutrition provided. Dichotomous variables were compared via Chi-square test. Continuous data were compared via student t-test or Mann-Whitney U test. Univariable linear regression was utilized to identify variables associated with LOS (p < 0.05) to analyze further. Cox Proportional Hazard Model was utilized to analyze association with LOS, while censoring for death, and controlling for TBSA, age, presence of inhalation injury, and potential for a center effect. Results Of 1,147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, p < 0.001), acute kidney injury (AKI) requiring RRT (7.3 vs 1.7%, p = 0.009), more days requiring vasopressors (mean 1.24 vs 0.58 days, p = 0.008), and fewer ventilator free days of the first 28 days (mean 22.9 vs 25.1, p < 0.001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, the best fit model included only deficiency and days until vitamin D initiation. Conclusions Patients with thermal injuries and vitamin D deficiency on admission have increased length of stay and worsened clinical outcomes as compared to patients with sufficient vitamin D concentrations.

5 -Year Retrospective Analysis of a Vented Mobility Algorithm in the Burn ICU

2022 ◽  
Author(s):  
Audrey Marie O'Neil ◽  
Cassandra Rush ◽  
Laura Griffard ◽  
David Roggy ◽  
Allison Boyd ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Recent Literature ◽  
Total Body Surface Area ◽  
Early Mobilization ◽  
Burn Patients ◽  
Mechanically Ventilated ◽  
Line Placement ◽  
Total Body ◽  
Stage 1 ◽  
Significant Attention

Abstract Early mobilization with mechanically ventilated patients has received significant attention within recent literature, however limited research has focused specifically on the burn population. The purpose of this single center, retrospective analysis was to review the use of a burn critical care mobility algorithm, to determine safety and feasibility of a burn vented mobility program, share limitations preventing mobility progression at our facility, and discuss unique challenges to vented mobility with intubated burn patients. A retrospective review was completed for all intubated burn center admissions between January 2015 to December 2019. Burn Therapy notes were then reviewed for data collection, during the intubation period, using stages of the mobility algorithm. In 5 years following initial implementation, the vented mobility algorithm was utilized on 127 patients with an average total body surface area of 22.8%. No adverse events occurred. Stage 1 (Range of motion) was completed with 100% of patients (n=127). Chair mode of bed, stage 2a, was utilized in 39.4%(n=50) of patients, while 15.8% (n=20) of patients were dependently transferred to the cardiac chair in stage 2b. Stage 3 (sitting on the edge-of-bed) was completed with 25% (n=32) of patients, with 11% (n=14) progressing to stage 5 (standing), and 3.9% (n=5) actively transferring to a chair. In 5 years, only 4.7% (n=6) reached stage 6 (ambulation). The most common treatment limitations were medical complications (33%) and line placement (21%). Early mobilization during mechanical ventilation is safe and feasible within the burn population, despite challenges including airway stability, sedation, and line limitations.

scholarly journals Multimodal Analgesia and Discharge Opioid Requirements in Burn Patients

2020 ◽  
Vol 41 (5) ◽  
pp. 963-966
Author(s):  
Michael Wright ◽  
Jin A Lee
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Multimodal Analgesia ◽  
Burn Patients ◽  
Area Burned ◽  
Total Body ◽  
The Impact

Abstract Analgesia in burn patients is challenging given the complexity of burn pain and prolonged need beyond hospital admission. Given the risks of opioids, the impact of multimodal analgesia postdischarge needs to be further elucidated in this population. This retrospective, single-center cohort study evaluated adult burn patients who were consecutively admitted to the burn service with at least 10% total body surface area burned and subsequently followed in the burn clinic between February 2015 and September 2018. Subjects were separated into two cohorts based on discharge pain regimens: multimodal and nonmultimodal. The primary outcome was the change in opioid requirements (measured in oral morphine equivalents) between discharge and first follow-up interval. Secondary outcomes included the classes of multimodal agents utilized and a comparison of opioid requirements between the last 24 hours of admission and discharge. A total of 152 patients were included for analysis, 76 in the multimodal cohort and 76 in the nonmultimodal cohort. The multimodal cohort was noted to have increased total body surface area burned and prolonged number of days spent in the intensive care unit at baseline; however, the multimodal cohort exhibited a more significant decrease in opioid requirements from discharge to first follow-up interval when compared with the nonmultimodal cohort (106.6 vs 75.4 mg, P = .039).

1 The Impact of No Next of Kin Decision Makers on End-of-life Care

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S4-S5
Author(s):  
Ryan K Ota ◽  
Maxwell B Johnson ◽  
Trevor A Pickering ◽  
Warren L Garner ◽  
Justin Gillenwater ◽  
...  
Keyword(s):  
Critically Ill ◽  
Decision Maker ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Inclusion Criteria ◽  
Next Of Kin ◽  
Medical Decisions ◽  
Comfort Care ◽  
Burn Care ◽  
The Impact

Abstract Introduction For critically ill burn patients without a next of kin (NOK), the medical team is tasked with becoming the surrogate decision maker. This poses difficult ethical and legal challenges for burn providers. Despite this frequent problem, there has been no investigation of how the presence of a NOK affects treatment in burn patients. This study is the first to evaluate this relationship. Methods A retrospective chart review was performed on a cohort of patients who died during the acute phase of their burn care from a single burn center from 2015 to 2019. Inclusion criteria were age ≥18 years and mortality within 4-weeks of admission. Exclusion criteria were death from dermatologic disease or trauma. Variables collected included age, gender, mechanism of injury, length of stay (LOS), total body surface area (TBSA), revised Baux score, and the presence of a NOK. Fisher’s Exact Test and Student’s t-test were used for analysis. Results In total, 67 patients met inclusion criteria. Of these patients, 14 (21%) did not have a NOK involved in medical decisions. Table 1 shows the means and odds ratio between the two groups. Patients without a NOK were younger (p < 0.05), more likely to be homeless (p < 0.01), had higher TBSA (p < 0.01), had shorter LOS (p < 0.01), and were 5 times less likely to receive comfort care (p < 0.05). Gender and ethnicity were not statistically significant. Conclusions Patients without a NOK present to participate in medical decisions are transitioned to comfort care less often despite having a higher burden of injury. This disparity in standard of care between the two groups demonstrates a need for a cultural shift in burn care to prevent suffering of these marginalized patients. Burn providers should be empowered to reduce suffering when no decision maker is present. Applicability of Research to Practice We report that the absence of a NOK has a significant impact leading to a decreased initiation of comfort care in critically ill burn patients. National protocols should be created to allow burn providers to act as a surrogate to prevent prolonged suffering.

A Multicenter Evaluation of Outcomes Following the Use of Nebulized Heparin for Inhalation Injury (HIHI2 Study)

2020 ◽  
Vol 41 (5) ◽  
pp. 1004-1008
Author(s):  
Courtney L Cox ◽  
Allyson M McIntire ◽  
Kimberly J Bolton ◽  
David R Foster ◽  
Andrew C Fritschle ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Major Bleeding ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Control Group ◽  
Bleeding Events ◽  
Total Body

Abstract Inhalation injury causes significant morbidity and mortality secondary to compromise of the respiratory system as well as systemic effects limiting perfusion and oxygenation. Nebulized heparin reduces fibrin cast formation and duration of mechanical ventilation in patients with inhalation injury. To date, no study has compared both dosing strategies of 5000 and 10,000 units to a matched control group. This multicenter, retrospective, case-control study included adult patients with bronchoscopy-confirmed inhalation injury. Each control patient, matched according to age and percent of total body surface area, was matched to a patient who received 5000 units and a patient who received 10,000 units of nebulized heparin. The primary endpoint of the study was duration of mechanical ventilation. Secondary endpoints included 28-day mortality, ventilator-free days in the first 28 days, difference in lung injury scores, length of hospitalization, incidence of ventilator-associated pneumonia, and rate of major bleeding. Thirty-five matched patient trios met inclusion criteria. Groups were well-matched for age (P = .975) and total body surface area (P = .855). Patients who received nebulized heparin, either 5000 or 10,000 units, had 8 to 11 less days on the ventilator compared to controls (P = .001). Mortality ranged from 3 to 14% overall and was not statistically significant between groups. No major bleeding events related to nebulized heparin were reported. Mechanical ventilation days were significantly decreased in patients who received 5000 or 10,000 units of nebulized heparin. Nebulized heparin, either 5000 units or 10,000 units, is a safe and effective treatment for inhalation injury.

Outcomes in Ventilated Burn Patients With Acute Respiratory Distress Syndrome: An Evaluation of Early High-PEEP Strategy Using Berlin Criteria

2021 ◽  
Author(s):  
Travis L Perry ◽  
William Pinette ◽  
Jason Miner ◽  
Heather Lesch ◽  
Brittany Denny ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Clinical Outcomes ◽  
Distress Syndrome ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
High Peep ◽  
Burn Patients ◽  
Mechanically Ventilated

Abstract Acute respiratory distress syndrome (ARDS) remains a formidable sequela, complication, and mortality risk in patients with large burns with or without inhalation injury. Alveolar recruitment using higher Positive end expiratory pressures (PEEP) after the onset of ARDS has been tried with varying success. Studies have identified benefits for several rescue maneuvers in ARDS patients with refractory hypoxemia. A prophylactic strategy utilizing an early recruitment maneuver, however, has not, to our knowledge, been explored in ventilated burn patients. This study was designed to evaluate the natural progression and clinical outcomes of ARDS severity (mild, moderate, and severe) using Berlin criteria in ventilated burn patients treated with an early high-PEEP ventilator strategy. A single-center retrospective review of burn patients who were mechanically ventilated for greater than 48 hours utilizing an early high-PEEP >10 mmHg (10.36) ventilator strategy was performed at the Level 1 trauma and regional burn center in Wright State University. ARDS severity was defined according to the Berlin criteria and then compared to published results of ARDS severity, clinical outcomes, and mortality. Demographic data, as well as respiratory and clinical outcomes, were evaluated. Eighty-three patients met inclusion criteria and were evaluated. Utilizing the Berlin definition as a benchmark, 42.1% of patients met ARDS criteria on admission, and most patients (85.5%) developed ARDS within the first seven days: 28 (34%) mild, 32 (38.6%) moderate, and 11 (13.3%) severe ARDS. The mean percent total body surface area was 24.6 + 22.1, with 68.7% of patients diagnosed with inhalation injury. The highest incidence of ARDS was 57.8% on day 2 of admission. Most cases remained in the mild to moderate ARDS category with severe ARDS (2.4%) being less common by hospital day 7. Overall, 30-day in-hospital and inhalation injury mortality rates were 9.6% and 15.8%, respectively. No correlation was observed between plateau pressures (22.8), mean arterial pressures (84.4), or vasopressor requirements; and oxygen requirements down trended quickly over the first 24 to 48 hours. In our study, implementing prophylactic, immediate high-PEEP in mechanically ventilated burn patients was associated with trends toward decreased severity and rapid resolution of ARDS in the first week following burn injury. This correlated with low 30-day in-hospital mortality in this population. This short and less severe course suggests that early high-PEEP support may be a viable protective strategy in the treatment of ventilated burn patients with ARDS.

scholarly journals The Use of a Simple Three-Level Bronchoscopic Assessment of Inhalation Injury to Predict in-Hospital Mortality and Duration of Mechanical Ventilation in Patients with Burns

2018 ◽  
Vol 46 (1) ◽  
pp. 67-73 ◽  
Author(s):  
M. T. Aung ◽  
D. Garner ◽  
M. Pacquola ◽  
S. Rosenblum ◽  
J. McClure ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Body Surface ◽  
Odds Ratio ◽  
Total Body Surface Area ◽  
Severity Of Illness ◽  
Inhalation Injury ◽  
Inhalational Injury ◽  
Total Body ◽  
Duration Of Ventilation

Major burn centres in Australia use bronchoscopy to assess severity of inhalation injuries despite limited evidence as to how best to classify severity of inhalational injury or its relationship to patient outcomes. All patients with burns who were admitted to the intensive care unit (ICU) at The Alfred Hospital between February 2010 and July 2014 and underwent bronchoscopy to assess inhalational injury, were reviewed. Age, total body surface area burnt, severity of illness indices and mechanisms of injury were extracted from medical histories and local ICU and burns registries. Inhalational injury was classified based on the Abbreviated Injury Score and then grouped into three categories (none/mild, moderate, or severe injury). Univariable and multivariable analyses were undertaken to examine the relationship between inhalational injury and outcomes (in-hospital mortality and duration of mechanical ventilation). One hundred and twenty-eight patients were classified as having none/mild inhalational injury, 81 moderate, and 13 severe inhalation injury. Mortality in each group was 2.3% (3/128), 7.4% (6/81) and 30.7% (4/13) respectively. Median (interquartile range) duration of mechanical ventilation in each group was 26 (11–82) hours, 84 (32–232) hours and 94 (21–146) hours respectively. After adjusting for age, total body surface area burnt and severity of illness, only the severe inhalation injury group was independently associated with increased mortality (odds ratio 20.4 [95% confidence intervals {CI} 1.74 to 239.4], P=0.016). Moderate inhalation injury was independently associated with increased duration of ventilation (odds ratio 2.25 [95% CI 1.53 to 3.31], P <0.001), but not increased mortality. This study suggests that stratification of bronchoscopically-assessed inhalational injury into three categories can provide useful prognostic information about duration of ventilation and mortality. Larger multicentre prospective studies are required to validate these findings.

126 Multimodal Analgesia and Discharge Opioid Requirements in Burn Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S85-S85
Author(s):  
Jin A Lee ◽  
Michael Wright
Keyword(s):  
Total Body Surface Area ◽  
Oral Morphine ◽  
Multimodal Analgesia ◽  
Burn Patients ◽  
Post Discharge ◽  
Icu Length Of Stay ◽  
Total Body ◽  
Long Acting ◽  
The Impact

Abstract Introduction Analgesia in burn patients is significantly challenging given the complexity of burn pain. Opioids are a mainstay of therapy, but studies demonstrate varying outcomes with respect to the efficacy of adjunctive non-opioid agents in the treatment of burn pain. The need for analgesia extends beyond hospital admission—given the known risks of opioids, the impact of multimodal analgesia on opioid requirements post-discharge needs to be further elucidated in this population. Methods In this retrospective, single-center cohort study, adult burn patients who were consecutively admitted to the burn ICU service and subsequently followed in the burn clinic between 2/2015 and 9/2018 were evaluated up to 6 months post-discharge. The subjects were divided into two cohorts based on discharge pain regimens: multimodal vs non-multimodal. Individuals taking long-acting opioids prior to admission were excluded. The primary outcome was the change in oral morphine equivalents (OME) between discharge and follow up occurring between 2 - 6 weeks post-discharge. Secondary outcomes included the number of multimodal agents utilized and a comparison of OME between the last 24 hours of admission and discharge. Results A total of 152 patients were included for analysis (n= 76 per cohort). The multimodal cohort demonstrated increased total body surface area burned (23.9% ± 15.4 vs 16.6% ± 7.1; p &lt; 0.001) and prolonged number of days spent in the ICU (22.7 ± 23.1 vs 10.7 ± 8.9; p &lt; 0.001). The change in OME from discharge to first follow up was -106.6 mg in the multimodal vs -75.4 mg in the non-multimodal cohort (p = 0.039; figure 1). In each cohort, discharge OME did not statistically differ from last 24 hour OME (multimodal: p = 0.067; non-multimodal: p = 0.537). The most common non-opioid agents utilized were acetaminophen and gabapentin. Conclusions Despite extended ICU length of stay and larger TBSA, burn patients discharged with multimodal pain regimens demonstrated a statistically significant reduction in oral morphine equivalents from discharge to first follow up compared to those discharged on opioid-only regimens. Applicability of Research to Practice This study demonstrates promising results with respect to lowering discharge opioid requirements by utilizing a multimodal analgesic approach in the management of burn pain.

Burn-Center Quality Improvement: Are Burn Outcomes Dependent on Admitting Facilities and is There a Volume-Outcome “Sweet-Spot”?

2012 ◽  
Vol 78 (5) ◽  
pp. 559-566 ◽  
Author(s):  
Tjasa Hranjec ◽  
Florence E. Turrentine ◽  
George Stukenborg ◽  
Jeffrey S. Young ◽  
Robert G. Sawyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Body Surface Area ◽  
Significant Risk ◽  
Inhalation Injury ◽  
P Value ◽  
Burn Patients ◽  
Multivariable Logistic Regression Model ◽  
Risk Of Mortality ◽  
Volume Outcome ◽  
Total Body

Risk factors of mortality in burn patients such as inhalation injury, patient age, and percent of total body surface area (%TBSA) burned have been identified in previous publications. However, little is known about the variability of mortality outcomes between burn centers and whether the admitting facilities or facility volumes can be recognized as predictors of mortality. De-identified data from 87,665 acute burn observations obtained from the National Burn Repository between 2003 and 2007 were used to estimate a multivariable logistic regression model that could predict patient mortality with reference to the admitting burn facility/facility volume, adjusted for differences in age, inhalation injury, %TBSA burned, and an additional factor, percent full thickness burn (%FTB). As previously reported, all three covariates (%TBSA burned, inhalation injury, and age) were found to be highly statistically significant risk factors of mortality in burn patients (P value < 0.0001). The additional variable, %FTB, was also found to be a statistically significant determinant, although it did not greatly improve the multivariable model. The treatment/admitting facility was found to be an independent mortality predictor, with certain hospitals having increased odds of death and others showing a protective effect (decreased odds ratio). Hospitals with high burn volumes had the highest risk of mortality. Mortality outcomes of patients with similar risk factors (%TBSA burned, inhalation injury, age, and %FTB) are significantly affected by the treating facility and their admission volumes.

703 Evaluating the Risk Factors and the Time-course of High Intraocular Pressures in Severely Burned Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S182-S183
Author(s):  
Lucy Wibbenmeyer ◽  
Anthony P Mai ◽  
Erin M Shriver ◽  
Christopher Fortenbach ◽  
Kai Wang
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Vision Loss ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Inclusion Criteria ◽  
Post Injury ◽  
Calculated Volume ◽  
Total Body ◽  
Parkland Formula

Abstract Introduction Severely burned patients are at risk for high intraocular pressures (IOP) and permanent vision loss from orbital compartment syndrome (OCS). Identification of at-risk patients for timely intervention is critical. This study aims to identify OCS risk factors and determine IOP trends to guide optimum monitoring in burn patients. Methods Medical records of burn patients seen by the ophthalmology service between 2004 and 2019 were reviewed. Patients undergoing resuscitation were split into those with high IOPs (PHigh IOP; ≥ 26 mmHg) and those with normal IOPs (PControl; IOPs ≤ 25 mmHg). Additional analysis to determine the timing of IOP elevations was performed on 13 patients (6 from the resuscitation group and 7 with facial burns). Results 33 of the 430 patients reviewed met inclusion criteria. Twenty-six patients underwent resuscitation, 6 of whom had elevated IOPs. Analysis of the PHigh IOP (n = 6) and PControl (n = 20) groups showed that elevated IOPs were associated with larger total body surface area (TBSA) burned (p = 0.002), a higher likelihood of exceeding the IVY index (&gt; 250 ml/kg) (p = 0.018), and higher Parkland Formula calculated volume (p &lt; 0.001). Maximum IOP and actual fluid resuscitation volume were linearly related (p &lt; 0.001). Analysis of all patients with elevated IOP showed increases of 0.5 to 7 mmHg/hour with a highest absolute rise of 31 mmHg over 12 hours. All elevations occurred within 24 hours post injury. 8 patients had OCS, 2 of whom were not resuscitated due to small TBSA burns.33 of the 430 patients reviewed met inclusion criteria. Twenty-six patients underwent resuscitation, 6 of whom had elevated IOPs. Analysis of the PHigh IOP (n = 6) and PControl (n = 20) groups showed that elevated IOPs were associated with larger total body surface area (TBSA) burned (p = 0.002), a higher likelihood of exceeding the IVY index (&gt; 250 ml/kg) (p = 0.018), and higher Parkland Formula calculated volume (p &lt; 0.001). Maximum IOP and actual fluid resuscitation volume were linearly related (p &lt; 0.001). Analysis of all patients with elevated IOP showed increases of 0.5 to 7 mmHg/hour with a highest absolute rise of 31 mmHg over 12 hours. All elevations occurred within 24 hours post injury. 8 patients had OCS, 2 of whom were not resuscitated due to small TBSA burns. Conclusions While large TBSA burns, exceeding the Ivy Index, and Parkland Formula calculated volume are potential OCS risk factors in burn patients, 25% of the patients who developed OCS had facial burns and did not require resuscitation. Earlier involvement of ophthalmology and more frequent IOP checks in susceptible burn patients will help identify those most at risk for OCS and vision loss. Applicability of Research to Practice Both the characteristics and the timing of increased intraocular patients is critical to ensuring prompt involvement of the ophthalmology team and treatment of the eye to preserve vision.

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