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Precursors to oliguria during major burn resuscitation: An analysis of a prospective observational trial at 5 major US burn centers.
- Source :
-
Burns : journal of the International Society for Burn Injuries [Burns] 2024 Aug; Vol. 50 (6), pp. 1513-1518. Date of Electronic Publication: 2024 Mar 12. - Publication Year :
- 2024
-
Abstract
- Currently, urine output is the leading variable used to tailor fluid resuscitation in patients with large TBSA burns. However, this metric often lags with respect to resuscitation. Our group sought to identify derangements in variables that precede development of oliguria (<30 cc/hr) that we hypothesize will aid in more efficient resuscitation. We performed a retrospective analysis of 146 adult patients admitted within 4 h of a large TBSA (>20%) burn. We then divided them into two cohorts: those who developed oliguria within 6 h of admission and those who did not. Patients who experienced early oliguria had a higher incidence of invasive SBP < 90 (p = 0.02) or DBP < 40 (p = 0.009), lower minimum bicarbonate level (p = 0.04), more full thickness burns (p = 0.004), and higher TBSA (p = 0.01). More female patients were found in the oliguric group (p = 0.003). Multivariate analysis was used to develop a model to predict development of oliguria. When evaluated together, minimum DBP, sex, TBSA (or percent full thickness burn), and maximum base deficit constituted the most parsimonious model that significantly predicted oliguria (AUC = 0.92). Interestingly, the model lost significance when DBP was omitted, highlighting the importance of diastolic pressure in the development of oliguria.<br />Competing Interests: Declaration of Competing Interest The original Burn Resuscitation Decision Support System was developed in collaboration between the U.S. Army Institute of Surgical Research and the University of Texas Medical Branch at Galveston, TX. Following initial development, this technology was licensed to Arcos, Inc. (Missouri City, TX) for commercialization and FDA clearance under the trade name Burn Navigator. An author currently holds a patent related to the device - "Burn Patient Resuscitation System". Patent Number: US8597273B2. The authors report no conflict of interest.<br /> (Copyright © 2024 International Society of Burns Injuries. All rights reserved.)
- Subjects :
- Humans
Female
Male
Adult
Middle Aged
Prospective Studies
Retrospective Studies
Multivariate Analysis
Sex Factors
United States epidemiology
Young Adult
Aged
Oliguria etiology
Oliguria epidemiology
Burns therapy
Burns complications
Fluid Therapy methods
Resuscitation methods
Bicarbonates
Burn Units
Body Surface Area
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1409
- Volume :
- 50
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Burns : journal of the International Society for Burn Injuries
- Publication Type :
- Academic Journal
- Accession number :
- 38548572
- Full Text :
- https://doi.org/10.1016/j.burns.2024.03.007