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Predicting increased fluid requirements during the resuscitation of thermally injured patients.
J Trauma 2004; 56(2):404-13; discussion 413-4JT

Abstract

BACKGROUND

We determined whether factors present soon after burn predict which patients will receive more than 4 mL/kg/% burn during the first 24 hours, and whether total fluid intake during the first 24 hours (VOL) contributes to in-hospital mortality (MORT).

METHODS

We reviewed the records of patients admitted during 1987-97. The modified Brooke resuscitation formula was used. One hundred four patients met inclusion criteria: total body surface area burned (TBSA) > or = 20%; admission directly from the field; weight > 30 kg; no electric injury, mechanical trauma, or blood transfusions; and survival > or = 24 hours postburn. Eighty-nine records were complete.

RESULTS

Mean TBSA was 43%, mean full-thickness burn size was 21%, mean age was 41 years, mean VOL was 4.9 mL/kg/% burn, and mean lactated Ringer's volume was 4.4 mL/kg/% burn; 53% had inhalation injury. MORT was 25.8%. Mean urine output was 0.77 mL/kg/h. By linear regression, VOL was associated with weight (negatively) and full-thickness burn size (r2 = 0.151). By logistic regression, receipt of over 4 mL/kg/% burn was predicted at admission by weight (negatively) and TBSA; by 24 hours postburn, mechanical ventilation replaced TBSA. With respect to MORT, logistic regression of admission factors yielded a model incorporating TBSA and an age function; by 24 hours postburn, the worst base deficit was added.

CONCLUSION

Burn size and weight (negatively) were associated with greater VOL. However, a close linear relationship between burn size and VOL was not observed. Mechanical ventilation supplanted TBSA by 24 hours as a predictor of high VOL. Worst base deficit, TBSA, and an age function, but not VOL, were predictors of MORT.

Authors+Show Affiliations

US Army Institute of Surgical Research, Charleston, South Carolina, USA. lee.cancio@us.army.milNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

14960986

Citation

Cancio, Leopoldo C., et al. "Predicting Increased Fluid Requirements During the Resuscitation of Thermally Injured Patients." The Journal of Trauma, vol. 56, no. 2, 2004, pp. 404-13; discussion 413-4.
Cancio LC, Chávez S, Alvarado-Ortega M, et al. Predicting increased fluid requirements during the resuscitation of thermally injured patients. J Trauma. 2004;56(2):404-13; discussion 413-4.
Cancio, L. C., Chávez, S., Alvarado-Ortega, M., Barillo, D. J., Walker, S. C., McManus, A. T., & Goodwin, C. W. (2004). Predicting increased fluid requirements during the resuscitation of thermally injured patients. The Journal of Trauma, 56(2), pp. 404-13; discussion 413-4.
Cancio LC, et al. Predicting Increased Fluid Requirements During the Resuscitation of Thermally Injured Patients. J Trauma. 2004;56(2):404-13; discussion 413-4. PubMed PMID: 14960986.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicting increased fluid requirements during the resuscitation of thermally injured patients. AU - Cancio,Leopoldo C, AU - Chávez,Saturnino, AU - Alvarado-Ortega,Moisés, AU - Barillo,David J, AU - Walker,Steven C, AU - McManus,Albert T, AU - Goodwin,Cleon W, PY - 2004/2/13/pubmed PY - 2004/3/19/medline PY - 2004/2/13/entrez SP - 404-13; discussion 413-4 JF - The Journal of trauma JO - J Trauma VL - 56 IS - 2 N2 - BACKGROUND: We determined whether factors present soon after burn predict which patients will receive more than 4 mL/kg/% burn during the first 24 hours, and whether total fluid intake during the first 24 hours (VOL) contributes to in-hospital mortality (MORT). METHODS: We reviewed the records of patients admitted during 1987-97. The modified Brooke resuscitation formula was used. One hundred four patients met inclusion criteria: total body surface area burned (TBSA) > or = 20%; admission directly from the field; weight > 30 kg; no electric injury, mechanical trauma, or blood transfusions; and survival > or = 24 hours postburn. Eighty-nine records were complete. RESULTS: Mean TBSA was 43%, mean full-thickness burn size was 21%, mean age was 41 years, mean VOL was 4.9 mL/kg/% burn, and mean lactated Ringer's volume was 4.4 mL/kg/% burn; 53% had inhalation injury. MORT was 25.8%. Mean urine output was 0.77 mL/kg/h. By linear regression, VOL was associated with weight (negatively) and full-thickness burn size (r2 = 0.151). By logistic regression, receipt of over 4 mL/kg/% burn was predicted at admission by weight (negatively) and TBSA; by 24 hours postburn, mechanical ventilation replaced TBSA. With respect to MORT, logistic regression of admission factors yielded a model incorporating TBSA and an age function; by 24 hours postburn, the worst base deficit was added. CONCLUSION: Burn size and weight (negatively) were associated with greater VOL. However, a close linear relationship between burn size and VOL was not observed. Mechanical ventilation supplanted TBSA by 24 hours as a predictor of high VOL. Worst base deficit, TBSA, and an age function, but not VOL, were predictors of MORT. SN - 0022-5282 UR - https://www.unboundmedicine.com/medline/citation/14960986/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=14960986 DB - PRIME DP - Unbound Medicine ER -