A Volume-Restrictive Burn Resuscitation Bundle and the Incidence of Acute Kidney Injury
Roberto Cortez, Benjamin Hall, *David Heffernan, *Andrew Stephen, *Michael Connolly, *Charles Adams, William G. Cioffi, David T. Harrington;
Brown University/Rhode Island Hospital, Providence, RI
Objective: We hypothesize a computer-driven, volume-restrictive protocol, emphasizing early albumin administration and oliguria tolerance decreases resuscitation volumes while minimizing adverse outcomes in patients with over 20% TBSA burns.
Design: Retrospective review analyzing patients admitted to a single burn center since 2007
Setting: Single-institution, burn center
Patients: 40 patients over 20%TBSA burn
Interventions: 25 patients using modified Brooke formula and 15 patients using volume-restrictive bundle.
Main Outcome Measures: Cumulative fluid resuscitation rates (cc/kg/%TBSA); urine output (cc/kg/hr); time of anuria (hr); limb/abdominal compartment syndrome release; early death (within 72 hours of injury); kidney injury per post-burn day (PBD) 3 creatinine.
Results: The cohorts were not statistically different for age and %TBSA (p=0.85), presence of inhalational injury (p=0.41), existing cirrhosis (p=0.67), COPD (p=0.63), and malignancy (p=0.67). As compared to standard resuscitation protocol patients, computer-guided patients had significantly more hours of anuria in the first 24 hours (0.7 v. 2.7, p=0.002) without an increase in measured PBD3 creatinine (1.07 v. 1.11, p=0.89). Data trends suggest that standard resuscitation patients had more catastrophic resuscitation rates represented as cumulative resuscitation volumes (cc/kg/TBSA) greater than 8 (24% v. 7%, p=0.17) and 10 (24% vs. 0%, p=0.09), higher incidence of early death (20% v. 0%, p=0.14), and higher incidence of celiotomy for abdominal compartment syndrome (24% v. 0%, p=0.09) as compared to computer-driven patients.
Conclusions: Protocol-driven patients, despite receiving less volume and sustaining episodes of anuria did not demonstrate increased incidence of acute kidney injury. The computer protocol showed trends toward less catastrophic resuscitations, reduced rates of abdominal compartment syndrome and early death. The data from this pilot study suggest that a new bundled, computer-driven strategy may improve burn resuscitation.
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