A Novel Means to Classify Response to Resuscitation in the Severely Burned: Derivation of the KMAC Value
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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Background Resuscitation fluid rates following burn are currently guided by a weight and burn size formulae, then titrated to urine output. Traditionally, 24 h resuscitation is reported as volume of resuscitation received without direct consideration for the physiologic response. We propose an input-to-output ratio to describe the course of burn resuscitation and predict eventual outcomes. Methods We reviewed admissions to a burn center from January 2003 through August 2006. Inclusion criteria were 20TBSA, admission 8 h after burn, and survived 24 h. Demographics, input volume and urine output, and clinical outcomes were recorded. A ratio of input volume cckgTBSAh to urine output cckgh was calculated at 24 h. The ratio of fluid intake to urine output reflecting an expected response was developed 4 cckgTBSA 24 h 0.166 cckgTBSAh divided by 0.5 1.0 cc urinekgh for an expected range 0.166 0.334. Subjects were classified based upon the ratio over-responders 0.166, expected 0.166 0.334, or under-responders 0.334. Clinical outcomes were compared and concordance of classification to values was calculated at 12 h. Results 102 subjects met inclusion criteria 29 in the over-responders, 37 in the expected, and 36 in the under-responders. Resuscitation volume was directly proportional to the calculated ratio while urine output was inversely proportional. Group mortality was 21, 11, and 44, respectively, with a significant difference between the expected and under-responders p 0.002. We found decreased ventilator-free days in the under-responders, and when deaths were excluded, decreased ICU-free days as well p 0.05. Concordance of paired data gathered at 12 h and 24 h was 67 for the under-responder group. Conclusions We describe a novel ratio to classify acute resuscitation after severe burn including the patient s response. Such a classification is associated with eventual outcomes.
- Medicine and Medical Research