203 Vasopressor Use During Acute Fluid Resuscitation in Burn Patients

Abstract

It is not known why some burn patients require vasopressor (VP) drugs during the acute fluid resuscitation phase. The purpose of this study was to evaluate factors that predict VP administration during acute burn resuscitation. Retrospective analysis of patients with burns ≥ 20% TBSA admitted within 24 hours post burn (PB) to an adult regional ABA-verified burn center between 11/15/15 and 7/1/17. Patients that received a VP in the 1st 48 hours (PRESS) were compared to those who did not (NOPRESS). Values are shown as the mean ± SD or median (1st, 3rd quartiles) as appropriate. There were 49 patients that met inclusion criteria. Following exclusion for VP administration prior to arrival at the BC (n=3) or provision of comfort measures ≤ 24 hours PB (n=9), a study population of 37 subjects remained. This population’s characteristics were age 47 ± 16 yrs, 35% female, with %TBSA burn 32 (24.5,49.2) and % full thickness burn 20.5 (3.3,39.8), and 32% with inhalation injury (INH). In the PRESS group, VPs were initiated at 24.3 ± 13 h PB, and were continued for 13.9 ± 10.5 h during the 1st 48 h PB period. The total amount of resuscitation fluid administered up to the initiation of VPs was 4.1 ± 2.2 mL/kg/%TBSA burn, and at the start of VPs, 119.6 ± 55.1 % of predicted resuscitation fluid had been infused. The 1st VP was norepinephrine in all cases. Vasopressin was added in two cases and epinephrine was added in 4 cases. PRESS and NOPRESS are compared in the table. There were no differences between the groups in % of predicted resuscitation fluid administered at 6,12, and 24 h PB, urine output, use of propofol for sedation, or the dose of opioids and benzodiazepines at 24 and 48 hours PB. High dose vitamin C had been used in 47% of PRESS resuscitations and in 23% of NOPRESS resuscitations (p=0.127). Only age was a significant predictor of need for VPs [OR 1.17 (95%CI: 1.01–1.36)]. Advanced age appears to be the main predictor of the need to initiate VPs during acute fluid resuscitation after burns. However, this study is limited by a small sample size and other factors may be contributory. VPs may be required in older patients despite acceptable fluid provision, during acute burn resuscitation.