United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA.
Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.
J Burn Care Res. 2023 Mar 2;44(2):446-451. doi: 10.1093/jbcr/irac095.
The goal of burn resuscitation is to provide the optimal amount of fluid necessary to maintain end-organ perfusion and prevent burn shock. The objective of this analysis was to examine how the Burn Navigator (BN), a clinical decision support tool in burn resuscitation, was utilized across five major burn centers in the United States, using an observational trial of 300 adult patients. Subject demographics, burn characteristics, fluid volumes, urine output, and resuscitation-related complications were examined. Two hundred eighty-five patients were eligible for analysis. There was no difference among the centers on mean age (45.5 ± 16.8 years), body mass index (29.2 ± 6.9), median injury severity score (18 [interquartile range: 9-25]), or total body surface area (TBSA) (34 [25.8-47]). Primary crystalloid infusion volumes at 24 h differed significantly in ml/kg/TBSA (range: 3.1 ± 1.2 to 4.5 ± 1.7). Total fluids, including colloid, drip medications, and enteral fluids, differed among centers in both ml/kg (range: 132.5 ± 61.4 to 201.9 ± 109.9) and ml/kg/TBSA (3.5 ± 1.0 to 5.3 ± 2.0) at 24 h. Post-hoc adjustment using pairwise comparisons resulted in a loss of significance between most of the sites. There was a total of 156 resuscitation-related complications in 92 patients. Experienced burn centers using the BN successfully titrated resuscitation to adhere to 24 h goals. With fluid volumes near the Parkland formula prediction and a low prevalence of complications, the device can be utilized effectively in experienced centers. Further study should examine device utility in other facilities and on the battlefield.
烧伤复苏的目标是提供维持终末器官灌注和预防烧伤休克所需的最佳液体量。本分析的目的是检查 Burn Navigator（BN）在美国五个主要烧伤中心的使用情况，该工具是一种烧伤复苏的临床决策支持工具，使用了一项对 300 名成年患者的观察性试验。检查了患者的人口统计学特征、烧伤特征、液体量、尿量和与复苏相关的并发症。285 名患者符合分析条件。五个中心在平均年龄（45.5±16.8 岁）、体重指数（29.2±6.9）、中位数损伤严重程度评分（18[四分位距：9-25]）或总体表面积（TBSA）（34[25.8-47]）方面没有差异。24 小时时，晶体液的初始输注量以 ml/kg/TBSA 计（范围：3.1±1.2 至 4.5±1.7）存在显著差异。包括胶体、点滴药物和肠内液体在内的总液体量，在 ml/kg（范围：132.5±61.4 至 201.9±109.9）和 ml/kg/TBSA（范围：3.5±1.0 至 5.3±2.0）方面，在 24 小时时在各中心之间存在差异。使用成对比较进行的事后调整导致大多数部位之间的显著性丧失。92 名患者中共有 156 例与复苏相关的并发症。使用 BN 的经验丰富的烧伤中心成功地调整了复苏以符合 24 小时的目标。液体量接近 Parkland 公式预测值，并发症发生率低，该设备可在经验丰富的中心有效使用。进一步的研究应检查该设备在其他机构和战场上的实用性。
