Effects of obesity on burn resuscitation

Jennifer Rosenthal, Audra Clark, Stephanie Campbell, Melanie McMahon, Brett Arnoldo, Steven Wolf, Herb Phelan

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

The effects of obesity on resuscitation after severe burn are not well understood. Formulas to calculate 24-h resuscitation volumes incorporate body weight, which in obese patients often leads to excessive fluid administration and potential complications such as pulmonary edema, extremity or abdominal compartment syndrome, and longer mechanical ventilation. We evaluated the impact of obesity on 24-h fluid resuscitation after severe burn using a cohort of 145 adults admitted to the burn ICU from January 2014 to March 2017 with >20% total body surface area burns. Patients were divided into four groups based on body mass index: normal weight (index of <25), overweight (25–29.9), obese (30–39.9), and morbidly obese (>40). Median total body surface area burn was 39.4% (interquartile range: 23.5%–49.5%). Patients were 74.5% male and demographics and injury characteristics were similar across groups. Resuscitation volumes exceeded the predicted Parkland formula volume in the normal and overweight groups but were less than predicted in the obese and morbidly obese categories (p < 0.001). No difference was found in 24-h urine output between groups (p = 0.08). Increasing body mass index was not associated with increased use of renal replacement therapy. Only total body surface area burned, and age were independent predictors of hospital mortality (p < 0.001). We conclude that using body weight to calculate resuscitation in obese patients results in a predicted fluid volume that is higher than the volume actually given, which can lead to over-resuscitation if rates are not titrated regularly to address fluid responsiveness.

Original languageEnglish (US)
JournalBurns
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

Fingerprint

Resuscitation
Obesity
Body Surface Area
Body Mass Index
Body Weight
Intra-Abdominal Hypertension
Renal Replacement Therapy
Pulmonary Edema
Hospital Mortality
Burns
Artificial Respiration
Extremities
Demography
Urine
Weights and Measures
Wounds and Injuries

Keywords

  • Burn
  • Obesity
  • Parkland formula
  • Resuscitation

ASJC Scopus subject areas

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

Cite this

Rosenthal, J., Clark, A., Campbell, S., McMahon, M., Arnoldo, B., Wolf, S., & Phelan, H. (Accepted/In press). Effects of obesity on burn resuscitation. Burns. https://doi.org/10.1016/j.burns.2018.06.002

Effects of obesity on burn resuscitation. / Rosenthal, Jennifer; Clark, Audra; Campbell, Stephanie; McMahon, Melanie; Arnoldo, Brett; Wolf, Steven; Phelan, Herb.

In: Burns, 01.01.2018.

Research output: Contribution to journalArticle

Rosenthal, J, Clark, A, Campbell, S, McMahon, M, Arnoldo, B, Wolf, S & Phelan, H 2018, 'Effects of obesity on burn resuscitation', Burns. https://doi.org/10.1016/j.burns.2018.06.002
Rosenthal J, Clark A, Campbell S, McMahon M, Arnoldo B, Wolf S et al. Effects of obesity on burn resuscitation. Burns. 2018 Jan 1. https://doi.org/10.1016/j.burns.2018.06.002
Rosenthal, Jennifer ; Clark, Audra ; Campbell, Stephanie ; McMahon, Melanie ; Arnoldo, Brett ; Wolf, Steven ; Phelan, Herb. / Effects of obesity on burn resuscitation. In: Burns. 2018.
@article{665282aac2c8460faf5fd486966bb285,
title = "Effects of obesity on burn resuscitation",
abstract = "The effects of obesity on resuscitation after severe burn are not well understood. Formulas to calculate 24-h resuscitation volumes incorporate body weight, which in obese patients often leads to excessive fluid administration and potential complications such as pulmonary edema, extremity or abdominal compartment syndrome, and longer mechanical ventilation. We evaluated the impact of obesity on 24-h fluid resuscitation after severe burn using a cohort of 145 adults admitted to the burn ICU from January 2014 to March 2017 with >20{\%} total body surface area burns. Patients were divided into four groups based on body mass index: normal weight (index of <25), overweight (25–29.9), obese (30–39.9), and morbidly obese (>40). Median total body surface area burn was 39.4{\%} (interquartile range: 23.5{\%}–49.5{\%}). Patients were 74.5{\%} male and demographics and injury characteristics were similar across groups. Resuscitation volumes exceeded the predicted Parkland formula volume in the normal and overweight groups but were less than predicted in the obese and morbidly obese categories (p < 0.001). No difference was found in 24-h urine output between groups (p = 0.08). Increasing body mass index was not associated with increased use of renal replacement therapy. Only total body surface area burned, and age were independent predictors of hospital mortality (p < 0.001). We conclude that using body weight to calculate resuscitation in obese patients results in a predicted fluid volume that is higher than the volume actually given, which can lead to over-resuscitation if rates are not titrated regularly to address fluid responsiveness.",
keywords = "Burn, Obesity, Parkland formula, Resuscitation",
author = "Jennifer Rosenthal and Audra Clark and Stephanie Campbell and Melanie McMahon and Brett Arnoldo and Steven Wolf and Herb Phelan",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.burns.2018.06.002",
language = "English (US)",
journal = "Burns",
issn = "0305-4179",
publisher = "Elsevier Limited",

}

TY - JOUR

T1 - Effects of obesity on burn resuscitation

AU - Rosenthal, Jennifer

AU - Clark, Audra

AU - Campbell, Stephanie

AU - McMahon, Melanie

AU - Arnoldo, Brett

AU - Wolf, Steven

AU - Phelan, Herb

PY - 2018/1/1

Y1 - 2018/1/1

N2 - The effects of obesity on resuscitation after severe burn are not well understood. Formulas to calculate 24-h resuscitation volumes incorporate body weight, which in obese patients often leads to excessive fluid administration and potential complications such as pulmonary edema, extremity or abdominal compartment syndrome, and longer mechanical ventilation. We evaluated the impact of obesity on 24-h fluid resuscitation after severe burn using a cohort of 145 adults admitted to the burn ICU from January 2014 to March 2017 with >20% total body surface area burns. Patients were divided into four groups based on body mass index: normal weight (index of <25), overweight (25–29.9), obese (30–39.9), and morbidly obese (>40). Median total body surface area burn was 39.4% (interquartile range: 23.5%–49.5%). Patients were 74.5% male and demographics and injury characteristics were similar across groups. Resuscitation volumes exceeded the predicted Parkland formula volume in the normal and overweight groups but were less than predicted in the obese and morbidly obese categories (p < 0.001). No difference was found in 24-h urine output between groups (p = 0.08). Increasing body mass index was not associated with increased use of renal replacement therapy. Only total body surface area burned, and age were independent predictors of hospital mortality (p < 0.001). We conclude that using body weight to calculate resuscitation in obese patients results in a predicted fluid volume that is higher than the volume actually given, which can lead to over-resuscitation if rates are not titrated regularly to address fluid responsiveness.

AB - The effects of obesity on resuscitation after severe burn are not well understood. Formulas to calculate 24-h resuscitation volumes incorporate body weight, which in obese patients often leads to excessive fluid administration and potential complications such as pulmonary edema, extremity or abdominal compartment syndrome, and longer mechanical ventilation. We evaluated the impact of obesity on 24-h fluid resuscitation after severe burn using a cohort of 145 adults admitted to the burn ICU from January 2014 to March 2017 with >20% total body surface area burns. Patients were divided into four groups based on body mass index: normal weight (index of <25), overweight (25–29.9), obese (30–39.9), and morbidly obese (>40). Median total body surface area burn was 39.4% (interquartile range: 23.5%–49.5%). Patients were 74.5% male and demographics and injury characteristics were similar across groups. Resuscitation volumes exceeded the predicted Parkland formula volume in the normal and overweight groups but were less than predicted in the obese and morbidly obese categories (p < 0.001). No difference was found in 24-h urine output between groups (p = 0.08). Increasing body mass index was not associated with increased use of renal replacement therapy. Only total body surface area burned, and age were independent predictors of hospital mortality (p < 0.001). We conclude that using body weight to calculate resuscitation in obese patients results in a predicted fluid volume that is higher than the volume actually given, which can lead to over-resuscitation if rates are not titrated regularly to address fluid responsiveness.

KW - Burn

KW - Obesity

KW - Parkland formula

KW - Resuscitation

UR - http://www.scopus.com/inward/record.url?scp=85055740373&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055740373&partnerID=8YFLogxK

U2 - 10.1016/j.burns.2018.06.002

DO - 10.1016/j.burns.2018.06.002

M3 - Article

C2 - 30391062

AN - SCOPUS:85055740373

JO - Burns

JF - Burns

SN - 0305-4179

ER -