Predicting Increased Fluid Requirements During the Resuscitation of Thermally Injured Patients

Cancio, Leopoldo C.; Chávez, Saturnino; Alvarado-Ortega, Moisés; Barillo, David J.; Walker, Steven C.; McManus, Albert T.; Goodwin, Cleon W.

doi:10.1097/01.ta.0000075341.43956.e4

Cited by 130 publications

(63 citation statements)

References 22 publications

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“…This hesitation to decrease rates of fluid resuscitation was reported in other studies 17,22,23 exploring factors associated with overresuscitation and fluid creep in burn patients. The sense of urgency or the need to decrease fluids was not perceived as being as important as the need to increase fluids.…”

Section: Local Problemmentioning

confidence: 84%

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

Fahlstrom

Boyle

Makic

2013

Critical Care Nurse

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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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Section: Local Problemmentioning

confidence: 84%

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

Fahlstrom

Boyle

Makic

2013

Critical Care Nurse

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“…We previously reviewed our experience with fluid resuscitation in a smaller number of burn patients. 33 In that study, the lowest BE recorded during the first 24 h after burn was an independent predictor of mortality (along with age and burn size), but not of increased fluid resuscitation volume. Others have shown that inadequate prehospital fluid resuscitation, manifested by a lower BE on admission and by a delay in establishing intravenous access, is associated with increased mortality.…”

Section: Discussionmentioning

confidence: 96%

Base Deficit and Alveolar–Arterial Gradient During Resuscitation Contribute Independently But Modestly to the Prediction of Mortality After Burn Injury

Cancio

Galvez

Turner

et al. 2006

Journal of Burn Care & Research

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The main determinants of mortality after burn injury that can be measured on admission include age, total burn size (% burn), and inhalation injury (INHAL). Other variables, measured during resuscitation, may provide additional information about injury severity. We assessed the utility of early arterial blood gas (ABG) data in predicting mortality after burn injury. Data were limited to samples obtained during the first 2 days after burn injury and to those obtained during high-frequency percussive ventilation. Mean values for each patient's ABG data were calculated; subsequent analysis used these derived variables. Logistic regression analysis (LRA) was used to generate a mortality predictor using burn, age (as a cubic age score, AGE), and INHAL. LRA was then repeated with the ABG variables. A total of 162 patients were included. By univariate analysis, death was associated with increased alveolar-arterial gradient (AaDO2), AGE, % burn, full-thickness burn size, INHAL, and with decreased pH and base excess. LRA of % burn, AGE, INHAL, and full-thickness burn size retained the first three variables. The addition of ABG data demonstrated that mean burn excess and mean AaDO2 also contributed independently to mortality. However, there was no difference in accuracy (86%) between the two equations. By Kaplan Meier analysis, AaDO2 but not BE predicted earlier death in those who died. Measured during resuscitation, metabolic acidosis (ie, a base deficit) and oxygenation failure (ie, increased AaDO2) contributed independently, but modestly, to ultimate mortality after burn injury. The inclusion of these variables did not improve predictive accuracy. Whether therapies targeted at these endpoints would improve outcome is unknown.

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“…[18] Appropriate fluid resuscitation in patients with smoke inhalation injury is still subject to controversial debates. [19] This, of course, does not inevitably indicate that isolated smoke inhalation injury is associated with increased fluid requirements. By contrast, overresuscitation may increase pulmonary microvascular pressures and might thereby lead to increased edema formation under the high permeability conditions in early lung injury.…”

Section: Discussionmentioning

confidence: 99%

Management of Inhalation Injury and Respiratory Complications in Burns Intensive Care Unit

Kabalak

Yastı²

2012

Ulus Travma Acil Cerrahi Derg

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AMAÇİnhalasyon yaralanması yüksek mortalite oranlarına sahiptir ve belirgin kalıcı pulmoner fonksiyon bozukluğu riski taşımaktadır. İnhalasyon yaralanması ve sonuçları, klinik yönetiminde ana rol oynayan solunum terapistlerine, hemşirelere ve doktorlara ciddi zorluklar oluşturur. Çalış-mamızda inhalasyon yaralanmalı hasta serimizdeki klinik tecrübelerimizi ve noninvazif mekanik ventilatör (NIMV) desteğinin rolünü bildirmeyi amaçladık. GEREÇ VE YÖNTEMAnkara Numune Eğitim ve Araştırma Hastanesi Yanık Yoğun Bakım Ünitesi'nde Mart 2009 -Mart 2011 yılları arasında yatarak tedavi alan hastalardan inhalasyon hasarı nedeniyle solunum desteğine ihtiyaç duyanlar çalışma-ya alındı. BULGULARBu hastaların 37'sinde inhalasyon yaralanması vardı, mortalite oranı %13,5 olarak bulundu, hastaların 16'sında zorunlu entübasyon uygulanırken (altı hastada ilk 6 saatte ve 10 hastada klinik seyir sürecinde) diğer hastalara sadece (%67,8) NIMV desteği uygulandı. SONUÇNIMV desteğinin uygun modlarda uygulanması, inhalasyon yaralanmalı olgularda invaziv yöntemlerin gerekliliği-ni azaltmaktadır. NIMV desteğinin inhalasyon yaralanmalı yanık hastalarında uygulanmasını önermekteyiz.Anahtar Sözcükler: İnhalasyon yaralanması; medikal tedavi; solunum yönetimi; ventilatör desteği. BACKGROUNDInhalation injury has high mortality and carries a significant risk of permanent pulmonary dysfunction. Inhalation injury and its consequences impose difficulties for the respiratory therapists, nurses and doctors who play a central role in its clinical management. In this study, we aimed to report our clinical experience and the role of non-invasive mechanic ventilatory (NIMV) support in a series of inhalation-injured patients. METHODSPatients hospitalized at Ankara Numune Training and Research Hospital's Burns Intensive Care Unit between March 2009 and March 2011 was reviewed, and patients with required respiratory support due to inhalation injury were included in the study. RESULTSAmong the patients, 37 had inhalation injury, and their mortality was 13.5%. Of the 37 patients, 16 had mandatory intubation (6 in the first 6 hours and 10 in the clinical course); however, others (67.8%) had only NIMV support. CONCLUSIONApplication of NIMV support with proper modes decreases the need for invasive procedures in inhalation-injured patients. Based on our results, we propose the application of NIMV support in inhalation-injured burn patients.

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Predicting Increased Fluid Requirements During the Resuscitation of Thermally Injured Patients

Cited by 130 publications

References 22 publications

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

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

Base Deficit and Alveolar–Arterial Gradient During Resuscitation Contribute Independently But Modestly to the Prediction of Mortality After Burn Injury

Management of Inhalation Injury and Respiratory Complications in Burns Intensive Care Unit

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