Trend Analysis of Current Modalities for Monitoring Fluid Therapy in Patients With Large Burns: Echoing the Call for Better Resuscitation Indices.

The aim of this study was to investigate whether current standards at our institution have effectively monitored resuscitations of severely burned patients during the first 48 hours postburn. Demographics, injuries assessed by TBSA and full thickness (FT), and resuscitation volumes (lactated Ringer's [LR]) were compared for all patients and those who died or survived. Means and standard deviations of hourly indices (urinary output [UOP], lactate [LAC], base excess [BE]) vs LR were analyzed. Waveforms, four-quadrant concordance, and correlation were also employed to compare the trending abilities (hourly changes [∆]) of aforementioned variables vs LR. A total of 203 patients were included in the analysis. Of these patients, 71 (35%) died, and 50 (25%) had inhalation injuries. Mean age and weight were 47 ± 19 years and 87 ± 18 kg, respectively. Mean TBSA burned was 41 ± 20%, with a mean FT of 18 ± 24%. Importantly, normalized waveform plots demonstrated the inability of UO, LAC, and BE to follow hourly changes in LR. Correlation of these variables was weak (r>>-1). This was confirmed by concordance plots. Slopes in all groups demonstrated that UOP was a better resuscitative monitor than LAC or BE. ∆UOP responded to ∆LR better in patients who survived than died. Reliance on hourly UOP as the sole index of optimal resuscitation is not supported. This study echoed the call for better resuscitation indices.