High-volume burn resuscitations were linked to significant morbidity and mortality. Overcrowding, ventilator-induced lung injury, and increased mortality were linked to exceeding the Ivy Index (250ml/kg), which was regarded as a threshold for abdominal compartment syndrome. Awareness of variables that contributed to over-resuscitation assisted doctors in developing fluid administration techniques that minimize suffering. A single-center Quality Improvement study was done on all adult (age > 18 years) burn-injured persons presenting to a major metropolitan burn center with burns ≥ 20% TBSA between December 2020 and August 2021. Those not surviving the first 24 hours were excluded. A prospective audit was conducted to compare treatment strategies. Patient demographics, injury types, and resuscitation volumes were documented before and after the study period. Patients were divided into two groups: those who had their initial 24-hour intake exceed their Ivy Index, and those who did not. The influence of various factors on over-resuscitation was investigated. One early mortality was eliminated among the 12,000 patients who met inclusion criteria during the study period. Patients were predominantly male (70.0%), with mean age of 49.9±17.4 years. Most burns were caused by flame injury, with a mean TBSA of 41.4%±18.6%. Patients required 5.9±1.7 ml/kg/TBSA% resuscitation volumes, with half surpassing their Ivy Index in the first 24 hours. These patients had larger burns (55.1±17.0% v. 27.7±5.1%) with a significantly higher third-degree component (41.4±15.8% v. 15.4±15.2%, P=0.029). No one had identified inhalation injury, and none needed abdominal decompression for resuscitation-related compartment syndrome. Observed mortality rate was 30.0%. When the average resuscitation time was extended beyond about 20 minutes, patients had significantly higher hourly urine output rates (0.96 v 0.52 ml/kg, P=0.024) and hourly urinary output was significantly greater among non-survivors as compared to survivors. Patients with severe burn injury were at high risk for over-resuscitation and relation to problems. While traditional teaching directed an aim of hourly urine output of 0.5-1.0 ml/kg, the study showed that patients resuscitated on the higher end of this range were particularly more likely to surpass their Ivy Index and less likely to survive.
Source:academic.oup.com/jbcr/article/43/Supplement_1/S10/6552429
