Neurologic Complications Associated With Burn Injury and Resuscitation

Treatment for large burn injuries relies on adequate fluid resuscitation secondary to the severe systemic inflammatory response. With improved critical care and better understanding of the complications of over and under resuscitation, morbidity and mortality rates are decreasing. Neurologic complications are not often considered as an over-resuscitation complication after burn injury but may be considered an additional form of compartment syndrome-intracranial compartment syndrome; however, it has not been evaluated for a possible threshold similar to the Ivy Index for abdominal compartment syndrome.

This study was conducted as a single center, retrospective review of patients admitted to the Burn Intensive Care Unit within 24 h of injury and who received neuroimaging within 96 h. Patients were grouped based on the resuscitation volumes at ≤200 and >200 mL/kg for evaluation of the development of worsening neurologic findings.

Forty-one patients were available for review with 30 patients ≤200 mL/kg and 11 patients >200 mL/kg. Twenty-one patients (70.0%) and 7 patients (63.6%), < 200 and > 200 mL/kg respectively, has repeat imaging. Follow-up imaging was found to be worse in patients receiving greater than 200 mL/kg (85.7% versus 47.6%, P value 0.064).

Providers should be aware of the potential for neurologic sequelae of resuscitation that is often only found on imaging in patients receiving high-volume resuscitation for their burn injury.