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Acute renal dysfunction in severely burned adults

M T Chrysopoulo1, M G Jeschke, P Dziewulski

  • 1Department of Surgery, Shriners Hospitals for Children and University of Texas Medical Branch, Galveston 77550, USA.

The Journal of Trauma
|February 5, 1999
PubMed
Summary

Early fluid resuscitation and sepsis prevention are key to reducing mortality in adults with severe burns and acute kidney injury. These interventions significantly impact survival rates in thermally injured patients.

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Area of Science:

  • Medicine
  • Surgery
  • Nephrology

Background:

  • Mortality factors in burned children with acute renal failure are known.
  • Factors contributing to mortality in thermally injured adults with acute renal dysfunction remain under-identified.

Purpose of the Study:

  • To identify factors contributing to mortality in acutely burned adults with acute renal dysfunction.
  • To compare outcomes between two distinct treatment periods.

Main Methods:

  • Retrospective review of 1,404 adult burn patients admitted to the Blocker Burn Unit.
  • Identification of 76 patients with acute renal dysfunction, >30% total body surface area burns, and >10% full-thickness burns.
  • Division of patients into two groups based on admission date: 1981-1989 and 1990-1998.

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Main Results:

  • No significant difference in acute renal dysfunction (5.4% vs. 5.1%) or mortality (88% vs. 87%) between the two periods.
  • Survivors were significantly younger (<40 years) than nonsurvivors (p < 0.02).
  • Sepsis occurred in 44% of survivors versus 96% of nonsurvivors (p < 0.001); delayed fluid resuscitation (4.4 vs. 1.7 hours) was noted in nonsurvivors (p < 0.001).

Conclusions:

  • Early fluid resuscitation is critical for improving outcomes in burned adults.
  • Sepsis prevention is a significant factor in reducing mortality.
  • These interventions may decrease the incidence of acute renal dysfunction and mortality in this patient population.