Revision of an Adult Burn Center's Resuscitation Guideline Leads to Lower Resuscitation Requirements

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Critical Care

Background:

• The 2018 institutional burn resuscitation guideline update aimed to refine fluid management and discontinue high-dose ascorbic acid (HDAA) therapy.
• Previous protocols involved higher fluid resuscitation volumes (4 mL/kg/TBSA) and HDAA, with evolving evidence prompting a review.

Purpose of the Study:

• To compare the incidence of a composite safety outcome (acute kidney injury, intra-abdominal hypertension) between pre- and post-guideline update periods.
• To evaluate secondary outcomes including 24-hour resuscitation volumes, urine output, vasopressor use, and mechanical ventilation duration.

Main Methods:

• A retrospective study design was employed, comparing patient data from before and after the 2018 guideline implementation.
• The primary composite safety outcome and secondary clinical parameters were analyzed between the two groups.

Main Results:

• The composite safety outcome incidence was similar between pre- and post-guideline groups (40% vs 29%; P = .27).
• Significantly lower 24-hour resuscitation volumes (3.74 vs 2.94 mL/kg/TBSA; P < .01) and reduced urine output (1.26 vs 0.75 mL/kg/h; P < .01) were observed in the post-guideline group.
• No significant differences were found in vasopressor use, mechanical ventilation duration, or mortality.

Conclusions:

• A simplified burn resuscitation protocol, excluding HDAA and utilizing a lower initial fluid rate, effectively reduced total fluid resuscitation volumes.
• This updated protocol achieved reduced fluid administration without a statistically significant increase in adverse safety events, suggesting improved resuscitation efficiency.