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Burn Resuscitation Practices in North America: Results of the Acute Burn ResUscitation Multicenter Prospective Trial (ABRUPT)
Journal article   Open access   Peer reviewed

Burn Resuscitation Practices in North America: Results of the Acute Burn ResUscitation Multicenter Prospective Trial (ABRUPT)

David G Greenhalgh, Robert Cartotto, Sandra L Taylor, Jeffrey R Fine, Giavonni M Lewis, David J Smith, Michael A Marano, Angela Gibson, Lucy A Wibbenmeyer, James H Holmes, …
Annals of surgery, Vol.277(3), pp.512-519
03/2023
DOI: 10.1097/SLA.0000000000005166
PMCID: PMC8857312
PMID: 34417368
url
https://escholarship.org/content/qt1x53p8d2/qt1x53p8d2.pdfView
Open Access

Abstract

OBJECTIVESABRUPT was a prospective, non-interventional, observational study of resuscitation practices at 21 burn centers. The primary goal was to examine burn resuscitation with albumin or crystalloids alone, in order to design a future prospective randomized trial. SUMMARY BACKGROUND DATANo modern prospective study has determined whether to use colloids or crystalloids for acute burn resuscitation. METHODSPatients ≥ 18 years with burns ≥ 20% total body surface area (TBSA) had hourly documentation of resuscitation parameters for 48 hours. Patients received either crystalloids alone or had albumin supplemented to crystalloid based on center protocols. RESULTSOf 379 enrollees, two-thirds (253) were resuscitated with albumin and one-third (126) were resuscitated with crystalloid alone. Albumin patients received more total fluid than Crystalloid patients (5.2± 2.3 versus 3.7 ± 1.7 mL/kg/% TBSA burn/24 hours) but patients in the Albumin Group were older, had larger burns, higher admission Sequential Organ Failure Assessment (SOFA) scores, and more inhalation injury. Albumin lowered the in-to-out (I/O) ratio and was started ≤ 12 hours in patients with the highest initial fluid requirements, given >12 hours with intermediate requirements, and avoided in patients who responded to crystalloid alone. CONCLUSIONAlbumin use is associated with older age, larger and deeper burns, and more severe organ dysfunction at presentation. Albumin supplementation is started when initial crystalloid rates are above expected targets and improves the I/O ratio. The fluid received in the first 24 hours was at or above the Parkland Formula estimate.

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