The Association Between Fluid Administration and Outcome Following Major Burn

TLDR

Recent studies indicate that contemporary burn patients receive more fluid per percent total body surface area than in the past. The study aimed to identify patient and injury factors influencing fluid requirements and to evaluate how fluid volume affects outcomes after burn injury. Using multilinear regression, propensity score modeling, and logistic regression on 72 patients, the authors quantified how fluid volumes relate to outcomes. Higher fluid volumes were associated with increased odds of pneumonia (OR 1.92), bloodstream infection (OR 2.33), ARDS (OR 1.55), multiorgan failure (OR 1.49), and death (OR 1.74), with %TBSA, age, weight, and intubation status predicting fluid volume.

Abstract

To determine patient and injury variables that influence fluid requirements following burn injury and examine the association between fluid volume received and outcome.Fluid resuscitation remains the cornerstone of acute burn management. Recent studies suggest that patients today are receiving more fluid per percent total body surface area (TBSA) than in the past. Therefore, there is a need to better define the factors that impact fluid requirements and to determine the effects of fluid volumes on outcome.This study was part of a federally funded multicenter study. Multilinear regression analyses were performed to determine the patient and injury characteristics that most influenced fluid resuscitation volumes received. To assess the association of fluid volumes on outcome, propensity scores were developed to provide a predicted volume of fluid for each patient. Logistic models were then used to assess the impact of excess fluid beyond predicted volumes on outcome.Seventy-two patients were included in this analysis. Average patient age was 40.6 years and average TBSA was 44.5%. Average fluid volume received during the first 24 hours after injury was 5.2/mL/kg/TBSA. Significant predictors of fluid received included % TBSA, age, intubation status, and weight. Increased fluid volume received increased risk of development of pneumonia (odds ratio [OR] = 1.92), bloodstream infections (OR =2.33), adult respiratory distress syndrome (OR = 1.55), multiorgan failure (OR= 1.49), and death (OR = 1.74).TBSA, age, weight, and intubation status on admission were significant predictors of fluid received. Patients who received larger volumes of resuscitation fluid were at higher risk for injury complications and death.