Use of computerized decision support system for resuscitation of swine with inhalation injury and severe burns

Abstract

OBJECTIVETo assess the use of a computerized burn resuscitation decision support system (BRDSS) in swine with smoke inhalation and severe burns.METHODSWe designed BRDSS for fluid resuscitation of burn injuries. The system uses an internal fluid model to recommend hourly crystalloid rates based on a urine output (UO) target of 30–50mL/hr. A graphical display shows the subject's fluid status compared with Parkland [4mL/kg/% total body surface area (TBSA)] and Modified Brooke (2mL/kg/%TBSA) resuscitation formulas. Under intravenous anesthesia, female swine (n=7, 41.5 ± 1.8kg) received smoke inhalation injury and 40% TBSA flame burn. Resuscitation with lactated Ringer's was guided by BRDSS recommendations. Resuscitation was stopped when a maintenance fluid rate of 125mL/hr was achieved for at least 6 hours; this was considered an indicator of adequate resuscitation. Statistical analysis is by t‐test.RESULTSArterial base excess decreased from 0.5 ± 2.7 pre‐injury to −3.1 ± 2.2 post‐injury (p<0.05), and was restored to 0.8 ± 1.9 by 30 hours (p<0.05). Total 24‐hour resuscitation volume was 3.4 ± 0.3mL/kg/TBSA. Mean UO in the first 24 hours was 84.4 ± 15.4mL/hr.CONCLUSIONBRDSS successfully resuscitated all subjects in the study while achieving total 24‐hour resuscitation volumes between the Modified Brooke and Parkland formulas and maintaining adequate UO.SUPPORT: U.S. Army Institute of Surgical Research