1082: Prevalence of Kidney Injury in Burn Patients Requiring Fluid Resuscitation
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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Optimal fluid resuscitation during the first 48 hours in patients with large burns is critical for improving outcomes and avoiding burn shock. However, it is unclear what the effect of fluid management is on kidney function during the resuscitation phase of care. The purpose of this study was to examine the prevalence of acute kidney injury AKI during resuscitation. We hypothesized that AKI is common during burn resuscitation and correlates with extent of the burn injury. Methods We performed a retrospective review of consecutive patients admitted to our burn intensive care unit from December 2007 to April 2013 who were resuscitated using a computerized decision support system CDSS designed to optimize resuscitation. AKI was defined by the Acute Kidney Injury Network AKIN criteria and was assessed during the resuscitation period. Rates of AKIN were stratified by burn size. Results The cohort was composed of 241 subjects. Mean total body surface area TBSA burn was 40 20, weight was 84 19kg, and age was 46 19 years. AKI occurred in 54 n131 of patients with 43, 20, and 1 meeting criteria for AKIN 1, 2, and 3, respectively. There was a significant increase in overall AKIN rates for TBSA 30 43 vs. 63, p0.01 with AKIN 1 differing significantly from 31 to 53 p0.01. Development of AKI was significantly correlated with increased resuscitation volume ml kg, p0.001 and mortality p0.01. Increases in serum creatinine of 0.3 mgdl in the last 48 hours was the leading cause of potential AKIN classification 79, 104 of cases followed by low urinary output of 12 hours 19, n25 and low urinary output of 24 hours 2, n2. Conclusions Based on the AKIN criteria, patients undergoing burn fluid resuscitation appear to be at risk of AKI. The majority of patients with a TBSA greater than 30 will develop AKI based on increases to serum creatinine during resuscitation.
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