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. 2013 Jan-Feb;34(1):196-202.
doi: 10.1097/BCR.0b013e3182700965.

New management strategy for fluid resuscitation: quantifying volume in the first 48 hours after burn injury

Katrina B Mitchell  1 , Elie Khalil, Ann Brennan, Huibo Shao, Angela Rabbitts, Nicole E Leahy, Roger W Yurt, James J Gallagher
Affiliations

New management strategy for fluid resuscitation: quantifying volume in the first 48 hours after burn injury

Katrina B Mitchell et al. J Burn Care Res. 2013 Jan-Feb.

Abstract

This study evaluated a 24-hour resuscitation protocol, established a formula to quantify resuscitation volume for the second 24 hours, described the relationship between the first and second 24 hours, and identified which patients required high volumes. A protocol for patients with burn >15% TBSA was implemented in 2009. Initial fluid was based on the Parkland calculation and adjusted to meet a goal urine output. Protocol compliance was defined as appropriate fluid titration to maintain urine output. Resuscitation ratio in the second 24 hours was tabulated as total fluid /(evaporative loss + maintenance fluid + estimated colloid). Data were collected prospectively from 2009 to 2011. A Wilcoxon rank test compared differences between groups. Regression analyses analyzed volume administered. P < .05 was statistically significant. Forty patients with burn >15% TBSA met criteria for inclusion. Mean age, burn size, and resuscitation volumes in the first and second 24 hours (mean + SD) were 47+ 20.7 years, 29.9 + 14.6% TBSA, 7.4 + 3.7 ml/kg/% TBSA, and a ratio of 1.9 times expected volume (SD, 1.3), respectively. Protocol compliance was 34%. Intubation, older age, and increased narcotic administration correlated with higher resuscitation volumes. A higher resuscitation volume in the first 24 hours significantly correlated with a higher resuscitation volume in the second 24 hours (P < .001). In conclusion, there is a significant relationship between fluid administration in the first and second 24 hours of resuscitation; intubation, older age, and narcotics correlate with higher volumes. A formula for observed/expected volumes in the second 24 hours is total fluid/(evaporative loss + maintenance fluid +estimated colloid).

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Figures

Figure 1
Figure 1
Adult Fluid Resuscitation Algorithm
Figure 2
Figure 2
Equation for quantifying second 24 hours of resuscitation
Figure 3
Figure 3
1st 24 hours versus 2nd 24 hours resuscitation volume
Figure 4
Figure 4
Age and Resuscitation Volume
Figure 5
Figure 5
Ventilator dependence and resuscitation volume
Figure 6
Figure 6
Narcotics and resuscitation volume
Figure 7
Figure 7
CONSORT diagram showing the flow of participants through enrollment
See this image and copyright information in PMC

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