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New Management Strategy for Fluid Resuscitation: Quantifying Volume in the First 48 Hours After Burn Injury

Mitchell, Katrina B. MD*; Khalil, Elie MD*; Brennan, Ann RN; Shao, Huibo MS; Rabbitts, Angela RN, MS*; Leahy, Nicole E. RN, MPH; Yurt, Roger W. MD, FACS*; Gallagher, James J. MD*

doi: 10.1097/BCR.0b013e3182700965
Original Articles: 2012 ABA Papers

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).

From the *Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medical Center; New York Presbyterian Hospital; and Weill Cornell Medical College, New York.

The Clinical and Translational Science Center grant UL1-RR024996 supported the use of the REDCap data management system in this study. This work also was supported in part by a grant from the New York Firefighters Burn Center Foundation.

Address correspondence to Katrina B. Mitchell, MD, 1320 York Avenue, No.17R, New York, NY 10021.

© 2013 The American Burn Association