82 Retrospective Review of Burn Resuscitation Outcomes Between 4 mL and 2 mL as a Starting Guide for Parkland Formula

Abstract

Abstract Introduction The ABA changed their fluid resuscitation guideline in 2011 for adult thermal burn injury patients from 4 mL to 2 mL per kilogram body mass per percent total body surface area (%TBSA) affected as a starting point for the Parkland formula. The primary aim of this change was to reduce the incidence of over resuscitation. We implemented this guideline at our institution in 2013. This retrospective analysis compares burn resuscitation outcomes prior to and post guideline change. Methods After approval from IRB, we collected data for all adult thermal burn injury patients with >20% TBSA from 2010 to 2012 for pre group and 2014–2016 for post group. Demographics, injury mechanisms, 24 and 48 hr resuscitation volume, 24 and 48 hr urine output, 24 hr peak serum creatinine, and mortality data was collected. Pre and post implementation groups were compared for 24 and 48 hr resuscitation volume, 24 and 48 hr urine output, 24 and 48 hr peak serum creatinine with t-test using SAS software. Mortality rates were compared too. Results The data is presented in table below. There was a significant reduction in total volume of resuscitation at 24 and 48 hr after implementation of the new guideline. There was also a significant reduction in the average 24 and 48 hr fluids used in the Parkland formula for the post group. This was achieved without significant reduction in urine output or increase in serum creatinine. Mean TBSA for pre and post groups were 36.2% and 33.1% respectively. There was no significant difference between extent of burn injury between these two groups.There was no significant change in mortality rate between the groups. Conclusions We observed lower volume of resuscitation for major thermal burn injury patients after implementation of the new guideline without adverse effect on renal function or outcomes. Applicability of Research to Practice The current guideline serves as a useful starting point for healthcare providers, allowing them to further resuscitate patients with additional fluids if needed. This change accomplishes optimal urine output and serum creatinine levels, while also providing better control of fluids to avoid over resuscitation.