The association between fluid administration and outcome following major burn

A multicenter study

Matthew B. Klein, Douglas Hayden, Constance Elson, Avery B. Nathens, Richard L. Gamelli, Nicole S. Gibran, David N. Herndon, Brett Arnoldo, Geoff Silver, David Schoenfeld, Ronald G. Tompkins

Research output: Contribution to journalArticle

162 Citations (Scopus)

Abstract

OBJECTIVE: To determine patient and injury variables that influence fluid requirements following burn injury and examine the association between fluid volume received and outcome. BACKGROUND: Fluid resuscitation remains the cornerstone of acute burn management. Recent studies suggest that patients today are receiving more fluid per percent total body surface area (TBSA) than in the past. Therefore, there is a need to better define the factors that impact fluid requirements and to determine the effects of fluid volumes on outcome. METHODS: This study was part of a federally funded multicenter study. Multilinear regression analyses were performed to determine the patient and injury characteristics that most influenced fluid resuscitation volumes received. To assess the association of fluid volumes on outcome, propensity scores were developed to provide a predicted volume of fluid for each patient. Logistic models were then used to assess the impact of excess fluid beyond predicted volumes on outcome. RESULTS: Seventy-two patients were included in this analysis. Average patient age was 40.6 years and average TBSA was 44.5%. Average fluid volume received during the first 24 hours after injury was 5.2/mL/kg/TBSA. Significant predictors of fluid received included % TBSA, age, intubation status, and weight. Increased fluid volume received increased risk of development of pneumonia (odds ratio [OR] = 1.92), bloodstream infections (OR =2.33), adult respiratory distress syndrome (OR = 1.55), multiorgan failure (OR= 1.49), and death (OR = 1.74). CONCLUSION: TBSA, age, weight, and intubation status on admission were significant predictors of fluid received. Patients who received larger volumes of resuscitation fluid were at higher risk for injury complications and death.

Original languageEnglish (US)
Pages (from-to)622-628
Number of pages7
JournalAnnals of Surgery
Volume245
Issue number4
DOIs
StatePublished - Apr 2007

Fingerprint

Multicenter Studies
Body Surface Area
Odds Ratio
Resuscitation
Wounds and Injuries
Intubation
Weights and Measures
Propensity Score
Adult Respiratory Distress Syndrome
Pneumonia
Logistic Models
Regression Analysis
Infection

ASJC Scopus subject areas

  • Surgery

Cite this

Klein, M. B., Hayden, D., Elson, C., Nathens, A. B., Gamelli, R. L., Gibran, N. S., ... Tompkins, R. G. (2007). The association between fluid administration and outcome following major burn: A multicenter study. Annals of Surgery, 245(4), 622-628. https://doi.org/10.1097/01.sla.0000252572.50684.49

The association between fluid administration and outcome following major burn : A multicenter study. / Klein, Matthew B.; Hayden, Douglas; Elson, Constance; Nathens, Avery B.; Gamelli, Richard L.; Gibran, Nicole S.; Herndon, David N.; Arnoldo, Brett; Silver, Geoff; Schoenfeld, David; Tompkins, Ronald G.

In: Annals of Surgery, Vol. 245, No. 4, 04.2007, p. 622-628.

Research output: Contribution to journalArticle

Klein, MB, Hayden, D, Elson, C, Nathens, AB, Gamelli, RL, Gibran, NS, Herndon, DN, Arnoldo, B, Silver, G, Schoenfeld, D & Tompkins, RG 2007, 'The association between fluid administration and outcome following major burn: A multicenter study', Annals of Surgery, vol. 245, no. 4, pp. 622-628. https://doi.org/10.1097/01.sla.0000252572.50684.49
Klein, Matthew B. ; Hayden, Douglas ; Elson, Constance ; Nathens, Avery B. ; Gamelli, Richard L. ; Gibran, Nicole S. ; Herndon, David N. ; Arnoldo, Brett ; Silver, Geoff ; Schoenfeld, David ; Tompkins, Ronald G. / The association between fluid administration and outcome following major burn : A multicenter study. In: Annals of Surgery. 2007 ; Vol. 245, No. 4. pp. 622-628.
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AU - Gamelli, Richard L.

AU - Gibran, Nicole S.

AU - Herndon, David N.

AU - Arnoldo, Brett

AU - Silver, Geoff

AU - Schoenfeld, David

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N2 - OBJECTIVE: To determine patient and injury variables that influence fluid requirements following burn injury and examine the association between fluid volume received and outcome. BACKGROUND: Fluid resuscitation remains the cornerstone of acute burn management. Recent studies suggest that patients today are receiving more fluid per percent total body surface area (TBSA) than in the past. Therefore, there is a need to better define the factors that impact fluid requirements and to determine the effects of fluid volumes on outcome. METHODS: This study was part of a federally funded multicenter study. Multilinear regression analyses were performed to determine the patient and injury characteristics that most influenced fluid resuscitation volumes received. To assess the association of fluid volumes on outcome, propensity scores were developed to provide a predicted volume of fluid for each patient. Logistic models were then used to assess the impact of excess fluid beyond predicted volumes on outcome. RESULTS: Seventy-two patients were included in this analysis. Average patient age was 40.6 years and average TBSA was 44.5%. Average fluid volume received during the first 24 hours after injury was 5.2/mL/kg/TBSA. Significant predictors of fluid received included % TBSA, age, intubation status, and weight. Increased fluid volume received increased risk of development of pneumonia (odds ratio [OR] = 1.92), bloodstream infections (OR =2.33), adult respiratory distress syndrome (OR = 1.55), multiorgan failure (OR= 1.49), and death (OR = 1.74). CONCLUSION: TBSA, age, weight, and intubation status on admission were significant predictors of fluid received. Patients who received larger volumes of resuscitation fluid were at higher risk for injury complications and death.

AB - OBJECTIVE: To determine patient and injury variables that influence fluid requirements following burn injury and examine the association between fluid volume received and outcome. BACKGROUND: Fluid resuscitation remains the cornerstone of acute burn management. Recent studies suggest that patients today are receiving more fluid per percent total body surface area (TBSA) than in the past. Therefore, there is a need to better define the factors that impact fluid requirements and to determine the effects of fluid volumes on outcome. METHODS: This study was part of a federally funded multicenter study. Multilinear regression analyses were performed to determine the patient and injury characteristics that most influenced fluid resuscitation volumes received. To assess the association of fluid volumes on outcome, propensity scores were developed to provide a predicted volume of fluid for each patient. Logistic models were then used to assess the impact of excess fluid beyond predicted volumes on outcome. RESULTS: Seventy-two patients were included in this analysis. Average patient age was 40.6 years and average TBSA was 44.5%. Average fluid volume received during the first 24 hours after injury was 5.2/mL/kg/TBSA. Significant predictors of fluid received included % TBSA, age, intubation status, and weight. Increased fluid volume received increased risk of development of pneumonia (odds ratio [OR] = 1.92), bloodstream infections (OR =2.33), adult respiratory distress syndrome (OR = 1.55), multiorgan failure (OR= 1.49), and death (OR = 1.74). CONCLUSION: TBSA, age, weight, and intubation status on admission were significant predictors of fluid received. Patients who received larger volumes of resuscitation fluid were at higher risk for injury complications and death.

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