1082

Abstract

Abstract : Optimal fluid resuscitation during the first 48 hours in patients with large burns is critical for improving outcomes and avoiding burn shock. However, it is unclear what the effect of fluid management is on kidney function during the resuscitation phase of care. The purpose of this study was to examine the prevalence of acute kidney injury (AKI) during resuscitation. We hypothesized that AKI is common during burn resuscitation and correlates with extent of the burn injury. Methods: We performed a retrospective review of consecutive patients admitted to our burn intensive care unit from December 2007 to April 2013 who were resuscitated using a computerized decision support system (CDSS) designed to optimize resuscitation. AKI was defined by the Acute Kidney Injury Network (AKIN) criteria and was assessed during the resuscitation period. Rates of AKIN were stratified by burn size. Results: The cohort was composed of 241 subjects. Mean total body surface area (TBSA) burn was 40 20%, weight was 84 19kg, and age was 46 19 years. AKI occurred in 54% (n=131) of patients with 43%, 20%, and 1% meeting criteria for AKIN 1, 2, and 3, respectively. There was a significant increase in overall AKIN rates for TBSA 30% (43% vs. 63%, p0.01) with AKIN 1 differing significantly from 31% to 53% (p0.01). Development of AKI was significantly correlated with increased resuscitation volume (ml/ kg, p0.001) and mortality (p0.01). Increases in serum creatinine of 0.3 mg/dl in the last 48 hours was the leading cause of potential AKIN classification (79%, 104) of cases followed by low urinary output of 12 hours (19%, n=25) and low urinary output of 24 hours (2%, n=2). Conclusions: Based on the AKIN criteria, patients undergoing burn fluid resuscitation appear to be at risk of AKI. The majority of patients with a TBSA greater than 30% will develop AKI based on increases to serum creatinine during resuscitation.