Implementation of a Nurse-Driven Burn Resuscitation Protocol: A Quality Improvement Project

Background Burn resuscitation, including titration of fluids and administration of colloids, is often driven by physicians’ orders. Inconsistencies in burn resuscitation cause overresuscitation, which has adverse consequences. Methods Retrospective chart reviews were completed to evaluate fluid resuscitation and complications for 12 months before and after development and implementation of a nurse-driven burn resuscitation protocol. Results Before implementation of the protocol, results at 24 hours after injury indicated that 58% of patients were overresuscitated, had a serum level of lactate of at least 2 mmol/L (100%), and had complications (pulmonary edema 20%, abdominal compartment syndrome 7%, acute lung injury/acute respiratory distress syndrome 30%) within the first 5 days. Two outcomes differed from before to after implementation of the protocol: serum level of lactate at 24 hours (t37.8 =2.38, P =.007) and central venous pressure at 48 hours (t31 =2.27, P =.03). After implementation of the protocol, no patients had abdominal compartment syndrome develop. Conclusions Implementation of the nurse-driven burn resuscitation protocol improved nurses’ awareness and assessment of fluid status during resuscitation and improved patients’ outcomes.

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COMPLICATIONS OF BURN RESUSCITATION; INTRA-ABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME

The Journal of Trauma: Injury, Infection, and Critical Care ◽

10.1097/00005373-199907000-00107 ◽

1999 ◽

Vol 47 (1) ◽

pp. 222 ◽

Cited By ~ 3

Author(s):

L.P. Sue ◽

L.L. Fong ◽

L.L. Babashoff ◽

W.J. Dominic ◽

J.W. Davis ◽

...

Keyword(s):

Compartment Syndrome ◽

Abdominal Compartment Syndrome ◽

Abdominal Hypertension ◽

Abdominal Compartment ◽

Burn Resuscitation

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Animal model of the abdominal compartment syndrome as a single insult and as a second insult in rats

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502003001100005 ◽

2003 ◽

Vol 18 (spe) ◽

pp. 29-36 ◽

Cited By ~ 1

Author(s):

João Baptista de Rezende-Neto ◽

Alcino Lázaro da Silva ◽

José Renan Cunha-Melo

Keyword(s):

Mean Arterial Pressure ◽

Arterial Pressure ◽

Hemorrhagic Shock ◽

Compartment Syndrome ◽

Abdominal Compartment Syndrome ◽

Venous Pressure ◽

Male Rats ◽

Sprague Dawley ◽

Mechanically Ventilated ◽

Abdominal Compartment

The objective of this paper was to develop a clinically relevant abdominal compartment syndrome experimental model, as a single insult and as a second insult flowing hemorrhagic shock. In the single insult model, Sprague-Dawley male-rats are anesthetized, invasively monitored (central venous pressure and mean arterial pressure), and mechanically ventilated during intraperitoneal injection of air to provoke the abdominal compartment syndrome (25 mmHg) for 60 minutes. In the two insult model, Sprague-Dawley male-rats are anesthetized, invasively monitored (mean arterial pressure) and bled to a mean arterial pressure of 30 mmHg for 45 minutes. Fluid resuscitation is accomplished by infusing 0.9% sodium chloride solution (0.9% NaCl) 33.2 ml/kg plus 75% of shed blood volume. During this phase a laparotomy is performed. Two hours after the beginning of the hemorrhagic shock phase the animals are anesthetized, intubated (orotracheal), mechanically ventilated (mean arterial pressure), and the intra-abdominal pressure is increased to 25 mmHg for 60 minutes, as a second insult. A 0.9% NaCl solution is infused during this phase (45 ml/kg/h). Hemorrhagic shock and the abdominal compartment syndrome behave as clinically relevant additive insults.

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Abdominal Compartment Syndrome and Burn Resuscitation

Journal of Burn Care & Rehabilitation ◽

10.1097/00004630-200001001-00021 ◽

2000 ◽

Vol 21 ◽

pp. S145

Author(s):

M. Beebe ◽

L. Cancio ◽

C. Goodwin

Keyword(s):

Compartment Syndrome ◽

Abdominal Compartment Syndrome ◽

Abdominal Compartment ◽

Burn Resuscitation

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Abdominal compartment syndrome caused by ruptured abdominal aortic aneurysm in vena cava

Vojnosanitetski pregled ◽

10.2298/vsp0609843m ◽

2006 ◽

Vol 63 (9) ◽

pp. 843-846

Author(s):

Davor Music ◽

Bozina Radevic ◽

Goran Batricevic ◽

Aleksandar Filipovic

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Compartment Syndrome ◽

Abdominal Compartment Syndrome ◽

Venous Pressure ◽

Vena Cava ◽

Clinical Signs ◽

Intraabdominal Pressure ◽

Abdominal Aortic ◽

Abdominal Compartment

Background. Abdominal compartment syndrome (ACS) is a rapid increase in intra-abdominal pressure associated with multi-organs dysfunction. It is caused mostly by abdominal bleeding und massive volume compensation. Case report. We reported a 76-year-old patient admitted to the hospital with aortic abdominal aneurysm, 13.7 cm in diameter, ruptured in vena cava, which caused intraabdominal hypertension, the liver and kidney dysfunction, as well as circulation, respiration and metabolic disorders. Intraabdominal pressure was measured by bladder manometry. Central venous pressure and systemic arterial pressure were monitored continuously. Clinical signs were thrill and typical abdominal bruit. Aorto-caval fistula was diagnosed by the use of contrast computerized tomography. Caval endoaneurysmatic suture and aortobiiliac bypass with 18 ? 9 mm Dacron prothesis were performed. Haemodynamic changes were mostly corrected during the surgery. The complete correction of haemodynamics, liver, kidney, respiration and metabolic changes was established in the next few weeks. Conclusion. The ACS was caused by rupture of abdominal aortic aneurysm in vena cava followed by edema of the abdominal organs, retroperitoneum, abdominal wall and ascites. Caval endoaneurysmatic suture and aortobiiliac bypass with 18 ? 9 mm Dacron prothesis solved aortocaval fistula as well as all the organs and metabolic dysfunctions caused by ACS.

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