213 Evaluation of Vasopressor Use During Acute Burn Fluid Resuscitation

K O Pape; J Heard; B Grieve; C Galet; L Wibbenmeyer

doi:10.1093/jbcr/irz013.141

Abstract Introduction During fluid resuscitation (FR) for acute burns, patients may require vasopressor (VP) administration. Reasons for requiring VP during FR remains unclear. To date, no study has evaluated risk factors for requiring VP in burn shock, although one study indicated presumed sepsis and size of burn as risk factors for developing hypotension in burn patients requiring urgent intubation. In other shock states such as septic shock, various risk factors, including advanced age and comorbidities such as cancer, have been identified in limited studies in patients who decompensate despite adequate FR. We sought to investigate risk factors to help predict which patients may require VP during acute burn FR. Methods This is a retrospective study of burn patients admitted to an ABA verified burn center over a five-year period who received FR. Patients who died within 24 hours were excluded. Basic demographics, medications prior to admission, laboratory results, fluids, urine output, mortality, length of stay (LOS), and mortality prediction scores were collected. VP administration during FR was defined as any VP administered during the first 48 hours. Univariate analyses were performed using SPSS 25.0. P < 0.05 was considered significant. Results A total of 111 patients met the inclusion criteria with 20 (18.0%) patients requiring VP during FR. VP were initiated 4.97 (± 11.2) hours after admission and were continued for 18.7 (± 45.9) hours in the VP group. Patients who required VP during FR were older (54.6 vs. 42.2 years, p = 0.032), had larger full thickness body surface area burned (37.7 vs. 14.5, p = 0.006), and had a higher revised Baux score (102.1 vs. 83.2, p = 0.001). No significant differences were observed regarding comorbidities or medications taken prior to admission, with the exception of patients who took dihydropyridine calcium channel blockers presenting a higher likelihood of requiring VP (15% vs. 3.3%, p = 0.038). Lactated Ringer’s requirements were higher in the first 24 hours for patients who received VP (15.9 L vs. 10.9 L, p = 0.014). VP administration did not affect LOS, but patients did have a higher rate of mortality (45% vs. 17.6%, p = 0.008) and dialysis requirement (10% vs. 0%, p = 0.002). Conclusions Older patients with higher Baux scores and greater amounts full-thickness burns are more likely to require VP during their acute burn FR. VP use was correlated with need for dialysis and mortality. Our study was limited by its retrospective nature and small sample size, thus additional risk factors may be identified in a larger study. Applicability of Research to Practice Larger studies are needed to identify risk factors in patients who require VP during burn FR. This remains a high risk group.

213 Evaluation of Vasopressor Use During Acute Burn Fluid Resuscitation

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