Hold the Pendulum

Abstract

Objective To determine whether restrictive fluid resuscitation results in increased rates of acute kidney injury (AKI) or infectious complications. Summary Background Data 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 three groups based on the pattern of resuscitation in the first 24 hours: volumes less than (restrictive), equal to, or greater than (excessive) standard resuscitation (4-6cc/kg/%TBSA). Multivariable regression analysis was employed to determine the effect of fluid group on AKI, burn wound infections (BWI), 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 (OR 3.25, 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.

<p>Intraoperative Urine Output Is Associated with Postoperative Outcome in Pediatric Population Undergone Major Abdominal Operations</p>

“…It has previously been believed that restrictive resuscitation is associated with increased AKI. However, analysis of urine in this study did not confirm these beliefs 27…”

Meta-Analysis of Renal Replacement Therapy for Burn Patients: Incidence Rate, Mortality, and Renal Outcome

“…Risk of bias is summarized in Supplementary Table 1 of the (cohort or case-control studies) and Supplementary Figure 1 of the (RCT studies). Among the 57 included studies, 22 were from North America ( 4 , 9 , 15 , 16 , 24 , 26 , 28 , 30 , 31 , 33 , 34 , 40 , 42 – 44 , 48 – 50 , 54 , 59 , 61 , 62 ), 18 were from Asia ( 5 , 7 , 19 , 21 – 23 , 25 , 36 – 38 , 41 , 46 , 47 , 51 , 52 , 58 , 64 , 67 ), 15 were from European countries ( 6 , 17 , 18 , 20 , 27 , 32 , 35 , 45 , 53 , 55 – 57 , 60 , 65 , 66 ), one was from South America ( 29 ), one was Africa ( 39 ). A total of 12 studies could not be used for analysis of the prevalence of RRT, seven of which only reported on RRT patients ( 9 , 18 , 34 , 37 , 38 , 43 , 45 ), four of which were RCT studies ( 40 , 41 , 51 ,…”

The P50 Research Center in Perioperative Sciences

“…Optimization of resuscitation protocols revealed the importance of rapid initiation, the complications induced by delayed resuscitation, the perils of over- and under-resuscitation, the benefits of guided fluid administration, utility of enteral resuscitation (especially for mass disaster scenarios), and considerations for special populations (e.g. pediatrics, pregnancy) (2, 4–8). Characterization of the hyperdynamic phase occurring 2–3 days post-burn showed low systemic vascular resistance, elevated cardiac output, systolic dysfunction, and increased myocardial energy demand (5, 9).…”