45 A Retrospective Review of the Use of Continuous Renal Replacement Therapy in the Treatment of Burn Patients

Abstract

Burns are multifaceted injuries with serious sequelae. Damage to the skin and underlying tissues represent just a portion of the injury. At the cellular level a complex chain of events occurs, potentially leading to end organ ischemia, acute kidney injury, renal insufficiency and/or frank renal failure. Intermittent hemodialysis or continuous renal replacement therapy (CRRT) are common modalities used to manage these conditions. The purpose of this study was to examine and compare the outcomes of patients requiring CRRT. A retrospective chart review of patients requiring CRRT from 2012–2017 was performed. Groups compared included patients started on CRRT within 3 days (ES) vs. those started after 3 days (LS) and survivors (S) vs non-survivors (NS). Of the 3,759 patients admitted during the study period 86 (2.3%) required CRRT. This represented 10.9% of ICU admissions (n =787). The mean time to initiation of CRRT was 13.2 ± 18.7days and mean duration of treatment was 13.4 ± 13.4 days. There were 42 (49%) ES patients and 44 (51%) LS. Survival rates did not differ significantly between ES (40.5%) and LS (43.2%), (p = .799). When comparing S (n = 36) (S) to NS (n=50) variables associated with death included age S 36 vs NS 56 years (p = .005), burns to the anterior trunk (p =.014), urine output S 0.471 vs. NS 0.257 ml/kg/hr (p = 0.016), norepinephrine dose S 8.996 vs NS 17.195 mcg/min (p = .021), pH S 7.41 vs NS 7.371 (p =.011), HCO3 S 27.138 vs NS 24.339 (p =.000), Base Excess S 2.671 vs NS -.575 (p=.000) and mean arterial pressure S 86.76 vs NS 71.94 (p =.000). Total body surface area (TBSA), Injury Severity Score (ISS) and inhalation injury were not associated with death. Of survivors, 5.8% were discharged on chronic hemodialysis, and the majority (86%) were discharged to post-acute care facilities. Acute renal failure (ARF) and the need for CRRT are commonly necessary in burn ICU patients. About half of these patients have early onset ARF, typically associated with resuscitation issues and/or pre-existing disease processes, and about half have late onset ARF typically associated with infection, sepsis, and multi-system organ failure. Overall survival in CRRT patients is 42% and we identified a number of risk factors associated with death. CRRT is an effective management tool in critically ill burn patients.