Hold the Pendulum

Rates of Acute Kidney Injury are Increased in Patients Who Receive Resuscitation Volumes Less than Predicted by the Parkland Equation

The Inflammation and the Host Response to Injury Collaborative Research Program

    Research output: Contribution to journalArticle

    21 Citations (Scopus)

    Abstract

    OBJECTIVE:: To determine whether restrictive fluid resuscitation results in increased rates of acute kidney injury (AKI) or infectious complications. BACKGROUND:: Studies demonstrate that patients often receive volumes in excess of those predicted by the Parkland equation, with potentially detrimental sequelae. However, the consequences of under-resuscitation are not well-studied. METHODS:: Data were collected from a multicenter prospective cohort study. Adults with greater than 20% total burned surface area injury were divided into 3 groups on the basis of the pattern of resuscitation in the first 24?hours: volumes less than (restrictive), equal to, or greater than (excessive) standard resuscitation (4 to 6?cc/kg/% total burned surface area). Multivariable regression analysis was employed to determine the effect of fluid group on AKI, burn wound infections (BWIs), and pneumonia. RESULTS:: Among 330 patients, 33% received restrictive volumes, 39% received standard resuscitation volumes, and 28% received excessive volumes. The standard and excessive groups had higher mean baseline APACHE scores (24.2 vs 16, P <0.05 and 22.3 vs 16, P <0.05) than the restrictive group, but were similar in other characteristics. After adjustment for confounders, restrictive resuscitation was associated with greater probability of AKI [odds ratio (OR) 3.25, 95% confidence interval (95% CI) 1.18–8.94]. No difference in the probability of BWI or pneumonia among groups was found (BWI: restrictive vs standard OR 0.74, 95% CI 0.39–1.40, excessive vs standard OR 1.40, 95% CI 0.75–2.60, pneumonia: restrictive vs standard, OR 0.52, 95% CI 0.26–1.05; excessive vs standard, OR 1.12, 95% CI 0.58–2.14). CONCLUSIONS:: Restrictive resuscitation is associated with increased AKI, without changes in infectious complications.

    Original languageEnglish (US)
    JournalAnnals of Surgery
    DOIs
    StateAccepted/In press - Jan 13 2016

    Fingerprint

    Acute Kidney Injury
    Resuscitation
    Odds Ratio
    Confidence Intervals
    Wound Infection
    Pneumonia
    APACHE
    Wounds and Injuries
    Cohort Studies
    Regression Analysis
    Prospective Studies

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Hold the Pendulum : Rates of Acute Kidney Injury are Increased in Patients Who Receive Resuscitation Volumes Less than Predicted by the Parkland Equation. / The Inflammation and the Host Response to Injury Collaborative Research Program.

    In: Annals of Surgery, 13.01.2016.

    Research output: Contribution to journalArticle

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    title = "Hold the Pendulum: Rates of Acute Kidney Injury are Increased in Patients Who Receive Resuscitation Volumes Less than Predicted by the Parkland Equation",
    abstract = "OBJECTIVE:: To determine whether restrictive fluid resuscitation results in increased rates of acute kidney injury (AKI) or infectious complications. BACKGROUND:: Studies demonstrate that patients often receive volumes in excess of those predicted by the Parkland equation, with potentially detrimental sequelae. However, the consequences of under-resuscitation are not well-studied. METHODS:: Data were collected from a multicenter prospective cohort study. Adults with greater than 20{\%} total burned surface area injury were divided into 3 groups on the basis of the pattern of resuscitation in the first 24?hours: volumes less than (restrictive), equal to, or greater than (excessive) standard resuscitation (4 to 6?cc/kg/{\%} total burned surface area). Multivariable regression analysis was employed to determine the effect of fluid group on AKI, burn wound infections (BWIs), and pneumonia. RESULTS:: Among 330 patients, 33{\%} received restrictive volumes, 39{\%} received standard resuscitation volumes, and 28{\%} received excessive volumes. The standard and excessive groups had higher mean baseline APACHE scores (24.2 vs 16, P <0.05 and 22.3 vs 16, P <0.05) than the restrictive group, but were similar in other characteristics. After adjustment for confounders, restrictive resuscitation was associated with greater probability of AKI [odds ratio (OR) 3.25, 95{\%} confidence interval (95{\%} CI) 1.18–8.94]. No difference in the probability of BWI or pneumonia among groups was found (BWI: restrictive vs standard OR 0.74, 95{\%} CI 0.39–1.40, excessive vs standard OR 1.40, 95{\%} CI 0.75–2.60, pneumonia: restrictive vs standard, OR 0.52, 95{\%} CI 0.26–1.05; excessive vs standard, OR 1.12, 95{\%} CI 0.58–2.14). CONCLUSIONS:: Restrictive resuscitation is associated with increased AKI, without changes in infectious complications.",
    author = "{The Inflammation and the Host Response to Injury Collaborative Research Program} and Mason, {Stephanie A.} and Nathens, {Avery B.} and Celeste Finnerty and Gamelli, {Richard L.} and Gibran, {Nicole S.} and Arnoldo, {Brett D.} and Tompkins, {Ronald G.} and David Herndon and Jeschke, {Marc G.}",
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    AU - The Inflammation and the Host Response to Injury Collaborative Research Program

    AU - Mason, Stephanie A.

    AU - Nathens, Avery B.

    AU - Finnerty, Celeste

    AU - Gamelli, Richard L.

    AU - Gibran, Nicole S.

    AU - Arnoldo, Brett D.

    AU - Tompkins, Ronald G.

    AU - Herndon, David

    AU - Jeschke, Marc G.

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    N2 - OBJECTIVE:: To determine whether restrictive fluid resuscitation results in increased rates of acute kidney injury (AKI) or infectious complications. BACKGROUND:: Studies demonstrate that patients often receive volumes in excess of those predicted by the Parkland equation, with potentially detrimental sequelae. However, the consequences of under-resuscitation are not well-studied. METHODS:: Data were collected from a multicenter prospective cohort study. Adults with greater than 20% total burned surface area injury were divided into 3 groups on the basis of the pattern of resuscitation in the first 24?hours: volumes less than (restrictive), equal to, or greater than (excessive) standard resuscitation (4 to 6?cc/kg/% total burned surface area). Multivariable regression analysis was employed to determine the effect of fluid group on AKI, burn wound infections (BWIs), and pneumonia. RESULTS:: Among 330 patients, 33% received restrictive volumes, 39% received standard resuscitation volumes, and 28% received excessive volumes. The standard and excessive groups had higher mean baseline APACHE scores (24.2 vs 16, P <0.05 and 22.3 vs 16, P <0.05) than the restrictive group, but were similar in other characteristics. After adjustment for confounders, restrictive resuscitation was associated with greater probability of AKI [odds ratio (OR) 3.25, 95% confidence interval (95% CI) 1.18–8.94]. No difference in the probability of BWI or pneumonia among groups was found (BWI: restrictive vs standard OR 0.74, 95% CI 0.39–1.40, excessive vs standard OR 1.40, 95% CI 0.75–2.60, pneumonia: restrictive vs standard, OR 0.52, 95% CI 0.26–1.05; excessive vs standard, OR 1.12, 95% CI 0.58–2.14). CONCLUSIONS:: Restrictive resuscitation is associated with increased AKI, without changes in infectious complications.

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