An Adjusted Ideal Body Weight Index Formula With Fresh Frozen Plasma (FFP) Rescue Decreases Fluid Creep During Burn...

Area of Science:

• Burn critical care
• Trauma resuscitation
• Nephrology

Background:

• Severe burn injuries necessitate substantial fluid resuscitation.
• Over-resuscitation poses significant risks, including mortality.
• Obese patients present unique challenges in fluid resuscitation due to adipose tissue vascularity.

Purpose of the Study:

• To compare the efficacy of an adjusted ideal body weight (AIBW) index formula with fresh frozen plasma (FFP) rescue against traditional Parkland-based resuscitation for severe burn injuries.
• To evaluate the impact of AIBW with FFP rescue on fluid administration volumes, acute kidney injury (AKI), and mortality rates.

Main Methods:

• Retrospective review of adult patients with ≥ 20% total body surface area (TBSA) burns admitted between 2010 and 2017.
• Comparison between patients resuscitated using AIBW with FFP rescue (n=40) and historical controls resuscitated with Parkland-based resuscitation (n=121).
• Outcomes analyzed using nonparametric statistics.

Main Results:

• The AIBW group received significantly less fluid resuscitation (3.30 vs. 4.15 mL/kg/%TBSA, p<0.001).
• A significant reduction in acute kidney injury requiring dialysis was observed in the AIBW group (5% vs. 19%, p=0.03).
• Improved mortality rates were noted in the AIBW group compared to controls (5% vs. 20%, p=0.03).

Conclusions:

• Utilizing an adjusted ideal body weight with fresh frozen plasma rescue for severe burn injury resuscitation leads to reduced fluid administration.
• This resuscitation strategy does not increase the incidence of acute kidney injury requiring dialysis.
• The adjusted ideal body weight with FFP rescue approach is associated with improved patient mortality.