91 Precursors to Oliguria During Acute Burn Resuscitation: A Secondary Analysis of a Prospective Observational Study

Abstract

Abstract Introduction Though commonly used to tailor fluid resuscitation, urine output may be a late indicator of impending burn shock. We sought to identify precedents of an early oliguric episode within 6 hours of admission. We hypothesize that specific variables may indicate early at-risk features during resuscitation. Methods We performed a secondary analysis of adults enrolled in the Burn Navigator resuscitation trial. We divided into two cohorts: those with oliguria (< 30ml/hr) and those without. Variables were compared by descriptive statistics. Results A total of 146 adults met inclusion criteria. More oliguric patients experienced systolic pressures < 90 mmHg (p=0.02) or Diastolic pressures < 40 mmHg (P=0.01). The minimum bicarbonate level (p=0.04), larger TBSA (p=0.01) and larger full thickness component (p=0.004) were all predictors of early oliguria. There were also more female patients (p=0.003) in the oliguric group. No cohort difference was observed for these variables: burn mechanism, percent partial thickness, HR >140 beats per minute (BPM) or hourly change in HR >10 BPM, temperature < 36C, hourly MAP drop >10 mmHg, creatine kinase, age, body mass index, hematocrit level, alcohol level, or methamphetamine use. Conclusions Specific variables and physiological derangement thresholds precedes the first oliguric episode during major burn resuscitation. These variables constitute at-risk features that may help derive future algorithms for efficient burn resuscitation. Applicability of Research to Practice Precursor variables of an early oligouric episode identify patients needing closer fluid titration.