- 作者：Joseph F. Kelly ; Daniel F. McLaughlin ; Jacob H. Oppenheimer ; John W. Simmons II ; Leopoldo C. Cancio ; Charles E. Wade ; Steven E. Wolf
- 关键词：Burn resuscitation ; KMAC ; Burn mortality
- 刊名：Burns
- 出版年：2013
- 出版时间：September, 2013
- 年：2013
- 卷：39
- 期：6
- 页码：1060-1066
- 全文大小：512 K
class=""h4"">Background
Resuscitation fluid rates following burn are currently guided by a weight and burn size formulae, then titrated to urine output. Traditionally, 24 h resuscitation is reported as volume of resuscitation received without direct consideration for the physiologic response. We propose an input-to-output ratio to describe the course of burn resuscitation and predict eventual outcomes.class=""h4"">Methods
We reviewed admissions to a burn center from January 2003 through August 2006. Inclusion criteria were ¡Ý20 % TBSA, admission ¡Ü8 h after burn, and survived ¡Ý24 h. Demographics, input volume and urine output, and clinical outcomes were recorded. A ratio of input volume (cc/kg/ % TBSA/h) to urine output (cc/kg/h) was calculated at 24 h. The ratio of fluid intake to urine output reflecting an ¡®expected¡¯ response was developed: 4 cc/kg/ % TBSA/24 h (0.166 cc/kg/ % TBSA/h) divided by 0.5-1.0 cc urine/kg/h for an expected range 0.166-0.334. Subjects were classified based upon the ratio: over-responders (<0.166), expected (0.166-0.334), or under-responders (>0.334). Clinical outcomes were compared and concordance of classification to values was calculated at 12 h.
class=""h4"">Results
102 subjects met inclusion criteria; 29 in the over-responders, 37 in the expected, and 36 in the under-responders. Resuscitation volume was directly proportional to the calculated ratio while urine output was inversely proportional. Group mortality was 21 % , 11 % , and 44 % , respectively, with a significant difference between the expected and under-responders (p < 0.002). We found decreased ventilator-free days in the under-responders, and when deaths were excluded, decreased ICU-free days as well (p < 0.05). Concordance of paired data gathered at 12 h and 24 h was 67 % for the under-responder group.
class=""h4"">Conclusions
We describe a novel ratio to classify acute resuscitation after severe burn including the patient's response. Such a classification is associated with eventual outcomes.