Chung Kevin K, Wolf Steven E, Cancio Leopoldo C, Alvarado Ricardo, Jones John A, McCorcle Jeffery, King Booker T, Barillo David J, Renz Evan M, Blackbourne Lorne H
United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA.
J Trauma. 2009 Aug;67(2):231-7; discussion 237. doi: 10.1097/TA.0b013e3181ac68cf.
In November 2005, institution of a military-wide burn resuscitation guideline requested the documentation of the initial 24-hour resuscitation of severely burned military casualties on a burn flow sheet to provide continuity of care. The guidelines instruct the providers to calculate predicted 24-hour fluid requirements and initial fluid rate based on the American Burn Association Consensus recommendation of 2 (modified Brooke) mL x kg(-1) x % total body surface area (TBSA)(-1) to 4 (Parkland) mL x kg(-1) x %TBSA(-1) burn. The objective of this study was to evaluate the relationship between the estimated fluid volumes calculated, either by the Modified Brooke or the Parkland formulas, and actual volumes received.
From November 2005 to December 2008, 105 patients were globally evacuated with >20% TBSA burns, of whom 73 had burn flow sheets initiated. Of these, 58 had completed burn flow sheets. Total fluids administered in the first 24-hour period for each patient were recorded. Chart reviews were performed to extract demographic and clinical outcomes data.
Of the 58, the modified Brooke formula was used in 31 patients (modified Brooke group) to estimate 24-hour fluid requirements and the Parkland formula was used in 21 (Parkland group). In six, 3 mL x kg(-1) x %TBSA(-1) was used and were excluded from analysis. No significant difference was detected between the two groups for age, %TBSA burned, inhalation injury, or Injury Severity Score. Actual 24-hour resuscitation in the modified Brooke group was significantly lower than in the Parkland group (16.9 L +/- 6.0 L vs. 25.0 L +/- 11.2 L, p = 0.003). A greater percentage of patients exceeded the Ivy index (250 mL/kg) in the Parkland group compared with the modified Brooke group (57% vs. 29%, p = 0.026). On average, those who had 24-hour fluid needs estimated by the modified Brooke formula received a 3.8 mL x kg(-1) x %TBSA(-1) +/- 1.2 mL x kg(-1) x %TBSA(-1) resuscitation, whereas the Parkland group received a 5.9 mL x kg(-1) x %TBSA(-1) +/- 1.1 mL x kg(-1) x %TBSA(-1) resuscitation (p < 0.0001). No differences in measured outcomes were detected between the two groups. On multivariate logistic regression, exceeding the Ivy index was an independent predictor of death (area under the curve [AUC], 0.807; CI, 0.66-0.95).
In severely burned military casualties undergoing initial burn resuscitation, the modified Brooke formula resulted in significantly less 24-hour volumes without resulting in higher morbidity or mortality.
2005年11月，全军烧伤复苏指南要求在烧伤流程表上记录重度烧伤军事伤员最初24小时的复苏情况，以确保护理的连续性。该指南指导医护人员根据美国烧伤协会的共识建议，即2（改良布鲁克）mL×kg⁻¹×总体表面积（TBSA）⁻¹%至4（帕克兰）mL×kg⁻¹×TBSA⁻¹%烧伤，来计算预计的24小时液体需求量和初始液体输注速率。本研究的目的是评估用改良布鲁克公式或帕克兰公式计算的估计液体量与实际输入量之间的关系。
2005年11月至2008年12月，105例TBSA烧伤>20%的患者被全球转运，其中73例启动了烧伤流程表。其中，58例完成了烧伤流程表。记录每位患者在最初24小时内输注的总液体量。进行病历审查以提取人口统计学和临床结局数据。
在这58例患者中，31例患者（改良布鲁克组）使用改良布鲁克公式估计24小时液体需求量，21例患者（帕克兰组）使用帕克兰公式。6例患者使用3 mL×kg⁻¹×TBSA⁻¹%，被排除在分析之外。两组在年龄、TBSA烧伤百分比、吸入性损伤或损伤严重程度评分方面未检测到显著差异。改良布鲁克组的实际24小时复苏量显著低于帕克兰组（16.9 L±6.0 L对25.0 L±11.2 L，p = 0.003）。与改良布鲁克组相比，帕克兰组超过艾维指数（250 mL/kg）的患者百分比更高（57%对29%，p = 0.026）。平均而言，那些用改良布鲁克公式估计2小时液体需求量的患者接受了3.8 mL×kg⁻¹×TBSA⁻¹%±1.2 mL×kg⁻¹×TBSA⁻¹%的复苏，而帕克兰组接受了5.9 mL×kg⁻¹×TBSA⁻¹%±1.1 mL×kg⁻¹×TBSA⁻¹%的复苏（p < 0.0001）。两组在测量结局方面未检测到差异。在多因素逻辑回归分析中，超过艾维指数是死亡的独立预测因素（曲线下面积[AUC]，0.807；CI，0.66 - 0.95）。
在接受初始烧伤复苏的重度烧伤军事伤员中，改良布鲁克公式导致24小时液体量显著减少，且未导致更高的发病率或死亡率。
