Vasopressor Use in Acute Burn Resuscitation: A Retrospective Study

Vasopressors are often introduced in severe burn patients who respond poorly to fluid resuscitation to maintain adequate blood pressure and avoid fluid creep. This study aims to characterise these patients and explore potential correlations between vasopressor use and patient outcomes.

Medical records from 2010 to 2023 for patients aged ≥ 18 years with burns ≥ 20% of the total body surface area (TBSA) were extracted from the TriNetX Research Network, a global federated health research platform aggregating de-identified electronic health records. The patients were divided into two groups: those who received vasopressors within the first 2 days of hospitalisation and those who did not. Statistical analysis included Cramér-von Mises and χ² test, with significance set at p < 0.05. Propensity score matching (PSM) in a 1:1 ratio was applied for the variables age, sex, pre-existing comorbidities (hypertension, diabetes, chronic heart disease, chronic lung disease, chronic kidney disease, and alcohol or opioid addiction), presence of inhalation injury, %TBSA burned, and burn injury year. Odds ratios (OR) for outcomes were calculated, with p-values adjusted for multiple testing using the Benjamini-Hochberg correction.

Of 6872 included patients, 17.7% received vasopressors within the first two days of hospitalisation. These patients were older, had more comorbidities and sustained more severe burns. After PSM we included 1206 patients in both cohorts (VP+ and VP-). Acute kidney injury occurred within 3 days in 51.0% of the VP+ group and 28.4% in VP- (OR 2.62, 95% CI: 2.20-3.11). VP+ patients also had higher rates of sepsis (30.8% vs. 22.9%, OR 1.50, 95% CI: 1.25-1.81) and higher mortality (45.1% vs. 32.7%, OR 1.69, 95% CI: 1.43-2.01) within 30 days following hospitalisation.

While vasopressors are frequently administered as part of burn resuscitation, their use was associated with higher rates of early acute kidney injury and an increased 30-day mortality rate.

Potent vasopressor use to support the circulation is commonly combined with fluid resuscitation in modern intensive care, and this is a prominent aspect of care in major burn cases. In this retrospective analysis of a commercial, de-identified health care dataset (primarily from US hospitals or health systems), matched cases over 14 recent years were analysed by early vasopressor use (or not) and then for important outcomes including mortality. Vasopressor use was associated with some complications and negative outcomes, though there are likely many factors which may contribute to negative outcomes which were not included in this analysis.