701 Outcome Evaluation of High Dose Ascorbic Acid Infusion in Adult Burn Patients

Abstract

Abstract Introduction High dose ascorbic acid (HDAA) infusion has been associated with lower resuscitation volumes following severe burn injuries. Recent data has linked the use of HDAA to an increased risk of renal failure. HDAA infusion causes an osmotic diuresis which confounds fluid titration. For these two reasons, HDAA has become controversial. The objective of this study is to examine the outcomes of adult burn patients who received HDAA infusion during acute burn resuscitation. Methods This study is an IRB approved retrospective chart review of all adult burn patients admitted from January 2016 through December 2018 who received HDAA for resuscitation. Patients were excluded if age < 18 years, had pre-existing hemodialysis-dependent chronic kidney disease, received < 16 hours of HDAA, or expired/withdrew from care within 48 hours of admission. The primary outcome was the incidence of patients receiving HDAA infusion who required renal replacement therapy (RRT) within 7 days of admission. Secondary outcomes included the incidence of abdominal compartment syndrome (ACS), duration of mechanical ventilation, actual crystalloid volume administered in the first 24 hours compared to estimated volume, ICU length of stay (LOS), and mortality. Results Twenty-four patients were included with a mean age of 48 (+/-16) and a mean TBSA of 49.1% (+/-17.8). The estimated fluid requirements in the 1st 24 hours were calculated using 4mL/kg/TBSA. Four patients required RRT (16.7%) and 12 patients were diagnosed with ACS (50%). The mean volume of crystalloid administered in the 1st 24 hours was 4.7 mL/kg/TBSA (+/-1.9), and the ratio of actual to estimated crystalloid in the 1st 24 hours was 1.2 (+/-0.5). Seventeen patients received albumin therapy in the 1st 24 hours. The mean urine output in 1st 24 hours was 1.7 mL/kg/hr. Mean duration of mechanical ventilation and ICU LOS was 15 and 16 days respectively. Thirteen patients died (54.2%). Conclusions The incidence of patients requiring RRT, along with the crystalloid volume administered and the observed to expected ratio of crystalloids in the 1st 24 hours were comparable to recent literature. The known effect of osmotic diuresis from HDAA potentially impacted fluid titration practice, increasing the risk of complications from over-resuscitation such as ACS, and mortality. Additionally, the estimation of 24-hour fluid requirements using 4mL/kg/TBSA may have contributed to the rates of ACS. Further studies comparing fluid management strategies are necessary. Applicability of Research to Practice This study describes the outcomes associated with HDAA during acute burn resuscitation at an adult burn center. Given the current controversy surrounding HDAA infusion, this study provides further data to help burn centers make a decision regarding their opinion of HDAA during acute burn resuscitation.