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

4 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.

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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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