Brooke Army Medical Center, Fort Sam, Houston, Texas, USA.
Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.
J Burn Care Res. 2023 Sep 7;44(5):1017-1022. doi: 10.1093/jbcr/irad065.
Initial fluid infusion rates for resuscitation of burn injuries typically use formulas based on patient weight and total body surface area (TBSA) burned. However, the impact of this rate on overall resuscitation volumes and outcomes have not been extensively studied. The purpose of this study was to determine the impact of initial fluid rates on 24-hour volumes and outcomes using the Burn Navigator (BN). The BN database is composed of 300 patients with ≥20% TBSA, >40 kg that were resuscitated utilizing the BN. Four study arms were analyzed based on the initial formula-2 ml/kg/TBSA, 3 ml/kg/TBSA, 4 ml/kg/TBSA or the Rule of Ten. Total fluids infused at 24 hours after admission were compared as well as resuscitation-related outcomes. A total of 296 patients were eligible for analysis. Higher starting rates (4 ml/kg/TBSA) resulted in significantly higher volumes at 24 hours (5.2 ± 2.2 ml/kg/TBSA) than lower rates (2 ml/kg/TBSA resulted in 3.9 ± 1.4 ml/kg/TBSA). No shock was observed in the high resuscitation cohort, whereas the lowest starting rate exhibited a 12% incidence, lower than both the Rule of Ten and 3 ml/kg/TBSA arms. There was no difference in 7-day mortality across groups. Higher initial fluid rates resulted in higher 24-hour fluid volumes. The choice of 2ml/kg/TBSA as initial rate did not result in increased mortality or more complications. An initial rate of 2ml/kg/TBSA is a safe strategy.
烧伤复苏的初始输液速率通常使用基于患者体重和全身表面积（TBSA）烧伤的公式。然而，这种速率对总体复苏量和结果的影响尚未得到广泛研究。本研究旨在使用烧伤导航仪（BN）确定初始液体速率对 24 小时容量和结果的影响。BN 数据库由 300 名 TBSA≥20%、体重>40kg 的患者组成，这些患者利用 BN 进行复苏。根据初始公式-2ml/kg/TBSA、3ml/kg/TBSA、4ml/kg/TBSA 或 10 法则，分析了四个研究组。比较了入院后 24 小时内输注的总液体量以及与复苏相关的结果。共有 296 名患者符合分析条件。较高的起始率（4ml/kg/TBSA）导致 24 小时后容量明显较高（5.2±2.2ml/kg/TBSA），而较低的起始率（2ml/kg/TBSA 导致 3.9±1.4ml/kg/TBSA）。高复苏组未观察到休克，而最低起始率的发生率为 12%，低于 10 法则和 3ml/kg/TBSA 组。各组 7 天死亡率无差异。较高的初始液体速率导致较高的 24 小时液体量。选择 2ml/kg/TBSA 作为初始速率不会增加死亡率或更多并发症。2ml/kg/TBSA 的初始速率是一种安全策略。
