A novel means to classify response to resuscitation in the severely burned: Derivation of the KMAC value

Joseph F. Kelly, Daniel F. McLaughlin, Jacob H. Oppenheimer, John W. Simmons, Leopoldo C. Cancio, Charles E. Wade, Steven Wolf

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Resuscitation fluid rates following burn are currently guided by a weight and burn size formulae, then titrated to urine output. Traditionally, 24 h resuscitation is reported as volume of resuscitation received without direct consideration for the physiologic response. We propose an input-to-output ratio to describe the course of burn resuscitation and predict eventual outcomes. Methods We reviewed admissions to a burn center from January 2003 through August 2006. Inclusion criteria were ≥20%TBSA, admission ≤8 h after burn, and survived ≥24 h. Demographics, input volume and urine output, and clinical outcomes were recorded. A ratio of input volume (cc/kg/%TBSA/h) to urine output (cc/kg/h) was calculated at 24 h. The ratio of fluid intake to urine output reflecting an 'expected' response was developed: 4 cc/kg/%TBSA/24 h (0.166 cc/kg/%TBSA/h) divided by 0.5-1.0 cc urine/kg/h for an expected range 0.166-0.334. Subjects were classified based upon the ratio: over-responders (<0.166), expected (0.166-0.334), or under-responders (>0.334). Clinical outcomes were compared and concordance of classification to values was calculated at 12 h. Results 102 subjects met inclusion criteria; 29 in the over-responders, 37 in the expected, and 36 in the under-responders. Resuscitation volume was directly proportional to the calculated ratio while urine output was inversely proportional. Group mortality was 21%, 11%, and 44%, respectively, with a significant difference between the expected and under-responders (p < 0.002). We found decreased ventilator-free days in the under-responders, and when deaths were excluded, decreased ICU-free days as well (p < 0.05). Concordance of paired data gathered at 12 h and 24 h was 67% for the under-responder group. Conclusions We describe a novel ratio to classify acute resuscitation after severe burn including the patient's response. Such a classification is associated with eventual outcomes.

Original languageEnglish (US)
Pages (from-to)1060-1066
Number of pages7
JournalBurns
Volume39
Issue number6
DOIs
StatePublished - Sep 1 2013
Externally publishedYes

Fingerprint

Resuscitation
Urine
Burn Units
Mechanical Ventilators
Demography
Weights and Measures
Mortality

Keywords

  • Burn mortality
  • Burn resuscitation
  • KMAC

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Kelly, J. F., McLaughlin, D. F., Oppenheimer, J. H., Simmons, J. W., Cancio, L. C., Wade, C. E., & Wolf, S. (2013). A novel means to classify response to resuscitation in the severely burned: Derivation of the KMAC value. Burns, 39(6), 1060-1066. https://doi.org/10.1016/j.burns.2013.05.016

A novel means to classify response to resuscitation in the severely burned : Derivation of the KMAC value. / Kelly, Joseph F.; McLaughlin, Daniel F.; Oppenheimer, Jacob H.; Simmons, John W.; Cancio, Leopoldo C.; Wade, Charles E.; Wolf, Steven.

In: Burns, Vol. 39, No. 6, 01.09.2013, p. 1060-1066.

Research output: Contribution to journalArticle

Kelly, JF, McLaughlin, DF, Oppenheimer, JH, Simmons, JW, Cancio, LC, Wade, CE & Wolf, S 2013, 'A novel means to classify response to resuscitation in the severely burned: Derivation of the KMAC value', Burns, vol. 39, no. 6, pp. 1060-1066. https://doi.org/10.1016/j.burns.2013.05.016
Kelly JF, McLaughlin DF, Oppenheimer JH, Simmons JW, Cancio LC, Wade CE et al. A novel means to classify response to resuscitation in the severely burned: Derivation of the KMAC value. Burns. 2013 Sep 1;39(6):1060-1066. https://doi.org/10.1016/j.burns.2013.05.016
Kelly, Joseph F. ; McLaughlin, Daniel F. ; Oppenheimer, Jacob H. ; Simmons, John W. ; Cancio, Leopoldo C. ; Wade, Charles E. ; Wolf, Steven. / A novel means to classify response to resuscitation in the severely burned : Derivation of the KMAC value. In: Burns. 2013 ; Vol. 39, No. 6. pp. 1060-1066.
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abstract = "Background Resuscitation fluid rates following burn are currently guided by a weight and burn size formulae, then titrated to urine output. Traditionally, 24 h resuscitation is reported as volume of resuscitation received without direct consideration for the physiologic response. We propose an input-to-output ratio to describe the course of burn resuscitation and predict eventual outcomes. Methods We reviewed admissions to a burn center from January 2003 through August 2006. Inclusion criteria were ≥20{\%}TBSA, admission ≤8 h after burn, and survived ≥24 h. Demographics, input volume and urine output, and clinical outcomes were recorded. A ratio of input volume (cc/kg/{\%}TBSA/h) to urine output (cc/kg/h) was calculated at 24 h. The ratio of fluid intake to urine output reflecting an 'expected' response was developed: 4 cc/kg/{\%}TBSA/24 h (0.166 cc/kg/{\%}TBSA/h) divided by 0.5-1.0 cc urine/kg/h for an expected range 0.166-0.334. Subjects were classified based upon the ratio: over-responders (<0.166), expected (0.166-0.334), or under-responders (>0.334). Clinical outcomes were compared and concordance of classification to values was calculated at 12 h. Results 102 subjects met inclusion criteria; 29 in the over-responders, 37 in the expected, and 36 in the under-responders. Resuscitation volume was directly proportional to the calculated ratio while urine output was inversely proportional. Group mortality was 21{\%}, 11{\%}, and 44{\%}, respectively, with a significant difference between the expected and under-responders (p < 0.002). We found decreased ventilator-free days in the under-responders, and when deaths were excluded, decreased ICU-free days as well (p < 0.05). Concordance of paired data gathered at 12 h and 24 h was 67{\%} for the under-responder group. Conclusions We describe a novel ratio to classify acute resuscitation after severe burn including the patient's response. Such a classification is associated with eventual outcomes.",
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AU - Kelly, Joseph F.

AU - McLaughlin, Daniel F.

AU - Oppenheimer, Jacob H.

AU - Simmons, John W.

AU - Cancio, Leopoldo C.

AU - Wade, Charles E.

AU - Wolf, Steven

PY - 2013/9/1

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N2 - Background Resuscitation fluid rates following burn are currently guided by a weight and burn size formulae, then titrated to urine output. Traditionally, 24 h resuscitation is reported as volume of resuscitation received without direct consideration for the physiologic response. We propose an input-to-output ratio to describe the course of burn resuscitation and predict eventual outcomes. Methods We reviewed admissions to a burn center from January 2003 through August 2006. Inclusion criteria were ≥20%TBSA, admission ≤8 h after burn, and survived ≥24 h. Demographics, input volume and urine output, and clinical outcomes were recorded. A ratio of input volume (cc/kg/%TBSA/h) to urine output (cc/kg/h) was calculated at 24 h. The ratio of fluid intake to urine output reflecting an 'expected' response was developed: 4 cc/kg/%TBSA/24 h (0.166 cc/kg/%TBSA/h) divided by 0.5-1.0 cc urine/kg/h for an expected range 0.166-0.334. Subjects were classified based upon the ratio: over-responders (<0.166), expected (0.166-0.334), or under-responders (>0.334). Clinical outcomes were compared and concordance of classification to values was calculated at 12 h. Results 102 subjects met inclusion criteria; 29 in the over-responders, 37 in the expected, and 36 in the under-responders. Resuscitation volume was directly proportional to the calculated ratio while urine output was inversely proportional. Group mortality was 21%, 11%, and 44%, respectively, with a significant difference between the expected and under-responders (p < 0.002). We found decreased ventilator-free days in the under-responders, and when deaths were excluded, decreased ICU-free days as well (p < 0.05). Concordance of paired data gathered at 12 h and 24 h was 67% for the under-responder group. Conclusions We describe a novel ratio to classify acute resuscitation after severe burn including the patient's response. Such a classification is associated with eventual outcomes.

AB - Background Resuscitation fluid rates following burn are currently guided by a weight and burn size formulae, then titrated to urine output. Traditionally, 24 h resuscitation is reported as volume of resuscitation received without direct consideration for the physiologic response. We propose an input-to-output ratio to describe the course of burn resuscitation and predict eventual outcomes. Methods We reviewed admissions to a burn center from January 2003 through August 2006. Inclusion criteria were ≥20%TBSA, admission ≤8 h after burn, and survived ≥24 h. Demographics, input volume and urine output, and clinical outcomes were recorded. A ratio of input volume (cc/kg/%TBSA/h) to urine output (cc/kg/h) was calculated at 24 h. The ratio of fluid intake to urine output reflecting an 'expected' response was developed: 4 cc/kg/%TBSA/24 h (0.166 cc/kg/%TBSA/h) divided by 0.5-1.0 cc urine/kg/h for an expected range 0.166-0.334. Subjects were classified based upon the ratio: over-responders (<0.166), expected (0.166-0.334), or under-responders (>0.334). Clinical outcomes were compared and concordance of classification to values was calculated at 12 h. Results 102 subjects met inclusion criteria; 29 in the over-responders, 37 in the expected, and 36 in the under-responders. Resuscitation volume was directly proportional to the calculated ratio while urine output was inversely proportional. Group mortality was 21%, 11%, and 44%, respectively, with a significant difference between the expected and under-responders (p < 0.002). We found decreased ventilator-free days in the under-responders, and when deaths were excluded, decreased ICU-free days as well (p < 0.05). Concordance of paired data gathered at 12 h and 24 h was 67% for the under-responder group. Conclusions We describe a novel ratio to classify acute resuscitation after severe burn including the patient's response. Such a classification is associated with eventual outcomes.

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KW - KMAC

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