A novel means to classify response to resuscitation in the severely burned: Derivation of the KMAC value

Joseph F. Kelly, Daniel F. McLaughlin, Jacob H. Oppenheimer, John W. Simmons, Leopoldo C. Cancio, Charles E. Wade, Steven E. Wolf

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Background Resuscitation fluid rates following burn are currently guided by a weight and burn size formulae, then titrated to urine output. Traditionally, 24 h resuscitation is reported as volume of resuscitation received without direct consideration for the physiologic response. We propose an input-to-output ratio to describe the course of burn resuscitation and predict eventual outcomes. Methods We reviewed admissions to a burn center from January 2003 through August 2006. Inclusion criteria were ≥20%TBSA, admission ≤8 h after burn, and survived ≥24 h. Demographics, input volume and urine output, and clinical outcomes were recorded. A ratio of input volume (cc/kg/%TBSA/h) to urine output (cc/kg/h) was calculated at 24 h. The ratio of fluid intake to urine output reflecting an 'expected' response was developed: 4 cc/kg/%TBSA/24 h (0.166 cc/kg/%TBSA/h) divided by 0.5-1.0 cc urine/kg/h for an expected range 0.166-0.334. Subjects were classified based upon the ratio: over-responders (<0.166), expected (0.166-0.334), or under-responders (>0.334). Clinical outcomes were compared and concordance of classification to values was calculated at 12 h. Results 102 subjects met inclusion criteria; 29 in the over-responders, 37 in the expected, and 36 in the under-responders. Resuscitation volume was directly proportional to the calculated ratio while urine output was inversely proportional. Group mortality was 21%, 11%, and 44%, respectively, with a significant difference between the expected and under-responders (p < 0.002). We found decreased ventilator-free days in the under-responders, and when deaths were excluded, decreased ICU-free days as well (p < 0.05). Concordance of paired data gathered at 12 h and 24 h was 67% for the under-responder group. Conclusions We describe a novel ratio to classify acute resuscitation after severe burn including the patient's response. Such a classification is associated with eventual outcomes.

Original languageEnglish (US)
Pages (from-to)1060-1066
Number of pages7
JournalBurns
Volume39
Issue number6
DOIs
Publication statusPublished - Sep 2013

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Keywords

  • Burn mortality
  • Burn resuscitation
  • KMAC

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Kelly, J. F., McLaughlin, D. F., Oppenheimer, J. H., Simmons, J. W., Cancio, L. C., Wade, C. E., & Wolf, S. E. (2013). A novel means to classify response to resuscitation in the severely burned: Derivation of the KMAC value. Burns, 39(6), 1060-1066. https://doi.org/10.1016/j.burns.2013.05.016