Eskenazi Health, Department of Pharmacy, 720 Eskenazi Avenue, Indianapolis, IN, 46202, United States.
Eskenazi Health, Richard M. Fairbanks Burn Center, 720 Eskenazi Avenue, Indianapolis, IN, 46202, United States.
Burns. 2019 Jun;45(4):869-875. doi: 10.1016/j.burns.2018.08.020. Epub 2019 Mar 29.
Electrical injuries are associated with significant morbidity for affected patients. While cardiac and surgical interventions have been extensively reported, no practice guidelines or studies have specifically addressed fluid delivery and associated outcomes of patients with electrical injuries. The study objective was to evaluate the differences in fluid delivery in patients with high (≥1000V) and low (<1000V) voltage electrical injuries.
This retrospective, observational study included adult electrical injury patients admitted for acute care. Patients with reported voltages were classified into high and low voltage subgroups. Primary outcomes of fluid administration and urine output over the first 24h after injury were assessed between subgroups. Secondary outcomes included renal, cardiac, surgical, and additional complications such as mortality, cost, and length of stay.
Data were analyzed in 36 patients with reported voltages, including 26 patients in the high and 10 patients in the low voltage subgroups. Patients in the high voltage subgroup had a statistically significant higher median (IQR) total IV fluid given [46.6 (22.4-61.9) vs. 22.5 (8.3-31.4) mL/kg, p=0.033] in the first 24h to achieve a similar urine output to the low voltage subgroup. The high voltage patients had higher rates of myoglobinuria, rhabdomyolysis, and creatinine kinase elevation. Patients in the high voltage vs. low voltage group had significantly longer median (IQR) length of stay (days) [11 (2-19) vs. 1 (1-6); p=0.015] and higher cost of hospital stay [$124,608 (19,486-296,991) vs. $16,165 (12,409-69,659); p=0.033].
These results reinforce the importance of assessing electrical injuries and obtaining a voltage to provide patient-specific care, as high voltage electrical injuries receive more fluid than estimated maintenance rates. This study is the first of its kind to characterize fluid given for high and low voltage electrical injuries and effects on patient outcomes.
电击伤会给患者带来严重的发病率。虽然心脏和外科干预措施已得到广泛报道，但尚无专门针对电击伤患者输液和相关结局的实践指南或研究。本研究旨在评估高（≥1000V）和低（＜1000V）电压电击伤患者在输液方面的差异。
本回顾性观察性研究纳入了因急性治疗而入院的成年电击伤患者。根据报告的电压，将患者分为高电压和低电压亚组。评估两组患者伤后 24 小时内的输液量和尿量等主要结局。次要结局包括肾脏、心脏、外科并发症以及死亡率、成本和住院时间等其他并发症。
共分析了 36 例报告电压的患者数据，其中高电压亚组 26 例，低电压亚组 10 例。高电压亚组患者伤后 24 小时内接受的中位（IQR）总静脉输液量[46.6（22.4-61.9）比 22.5（8.3-31.4）ml/kg，p=0.033]明显更高，以达到与低电压亚组相似的尿量。高电压患者肌红蛋白尿、横纹肌溶解和肌酸激酶升高的发生率更高。高电压组与低电压组患者的中位（IQR）住院时间（天）[11（2-19）比 1（1-6）；p=0.015]和住院费用[124608（19486-296991）比 16165（12409-69659）；p=0.033]均显著更长。
这些结果强调了评估电击伤和获取电压以提供个体化患者护理的重要性，因为高电压电击伤患者的输液量超过了估计的维持率。本研究首次对高、低电压电击伤患者的输液量及其对患者结局的影响进行了特征描述。
