502 Use of Hydrocortisone, Vitamin C, and Thiamine to Treat Burn Sepsis: A Case Series

Abstract

Abstract Introduction Sepsis remains a leading cause of morbidity and mortality in burn patients. Therefore, novel treatment adjuncts are of constant interest. Early studies by Marik et al. have suggested that bundled use of intravenous hydrocortisone, vitamin C, and thiamine may improve outcomes in intensive care patients diagnosed with systemic sepsis. However, to our knowledge, evaluation of this treatment modality has not been applied to burn patients. Methods Chart review of seven patients with major cutaneous injuries admitted to our burn center and treated with the adjunct therapy as per Marik et al. occurred. Baseline characteristics, treatment, and outcome variables were identified. Variables abstracted include demographics, injury characteristics, comorbidities, discharge disposition, length of stay, mechanical ventilation, use of vasopressors, acute kidney injury, blood cultures, white blood cell count, lactate, creatinine, predicted mortality (modified BAUX, APACHE II, APACHE IV, and SOFA scores), procalcitonin, quantitative culture and histology results, time to first excision, and time to final surgery and/or healing. Results Five patients sustained flame burns ranging from 24% to 46% total body surface area. One patient was admitted for road rash causing full thickness injury and one with toxic epidermal necrolysis encompassing 90% total body surface area. Ages ranged from 19 to 74 years. Modified BAUX with APACHE II and IV scores were used to predict baseline mortality risk. Four of the seven patients succumbed to their injuries, two within the first week of admission. Of the remaining cases, all required fewer vasopressors after beginning adjunct therapy. Among survivors, SOFA scores suggested greater than 95.2% predicted mortality at start of adjunct therapy and within four days, predicted mortality ranged from less than 33.3% to 50%. Conclusions The aim of this case series is to review our early experience with this novel treatment in burn patients. No conclusions can be drawn at this time. It is understood that continued research must be conducted to support correlation between intervention and outcomes. Optimism is present based upon early non-burn studies and our regional burn center experience. A prospective study is currently being developed at our burn center. Applicability of Research to Practice This case series explores a potential treatment adjunct to decrease morbidity and mortality from burn sepsis.