Low cardiac index and stroke volume on admission are associated with poor outcome in critically ill burn patients: a retrospective cohort study

Abstract

BackgroundImpact of early systemic hemodynamic alterations and fluid resuscitation on outcome in the modern burn care remains controversial. We investigate the association between acute-phase systemic hemodynamics, timing of fluid resuscitation and outcome in critically ill burn patients.MethodsRetrospective, single-center cohort study was conducted in a university hospital. Forty critically ill burn patients with total body surface area (TBSA) burn-injured >20 % with invasive blood pressure and cardiac output monitoring (transpulmonary thermodilution technique) within 8 h from trauma were included. We retrospectively examined hemodynamic variables during the first 24 h following admission, and their association with 90-day mortality.ResultsThe median (interquartile range 25th–75th percentile) TBSA, Simplified Acute Physiology Score II (SAPS II) and Abbreviated Burn Severity Index of the study population were 41 (29–56), 31 (23–50) and 9 (7–11) %, respectively. 90-Day mortality was 42 %. There was no statistical difference between the median pre-hospital and 24-h administered fluid volume in survivors and non-survivors. On admission, stroke volume (SV), cardiac index (CI), oxygen delivery index and mean arterial pressure (MAP) were significantly lower in patients who died despite similar fluid resuscitation volume. ROC curves comparing the ability of initial SV, CI, MAP and lactate to discriminate 90-day mortality gave areas under curves of, respectively, 0.89 (CI 0.77–1), 0.77 (CI 0.58–0.95), 0.73 (CI 0.53–0.93) and 0.78 (CI 0.63–0.92); (p value <0.05 for all). In multivariate analysis, SAPS II and initial SV were independently associated with 90-day mortality (best cutoff value for SV was 27 mL, sensitivity 92 %, specificity 69 %). During 24 h, no interaction was found between time and outcome regarding macrocirculatory parameters changes. Hemodynamic parameters improved during the first 24-h resuscitation in all patients but patients who died had lower SV and CI on admission, which remained through the first 24 h.ConclusionLow initial SV and CI were associated with poor outcome in critically ill burn patients. Very early hemodynamic monitoring may in help detecting under-resuscitated patients. Future prospective interventional studies should explore the impact of early goal-directed therapy in these specific patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0192-y) contains supplementary material, which is available to authorized users.

Usefulness of Cardiac Index to Predict Early and 30-Day Mortality in Non-Cardiac Patients Being Admitted to Intensive Care Units

“…However, only cardiac patients were assessed in their study. In another study by Soussi et al (13), 30-day mortality was considerably lower (42.0%) than that in our study, indicating that the condition of our patients was worse. However, consistent with our results, the CI assessed during admission in their study could also effectively predict early mortality.…”

A novel cross-linked haemoglobin-based oxygen carrier is beneficial to sepsis in rats

“…were developed [2], the treatment effect is not as good as expected, however. Microcirculation dysfunction and tissues' hypoxia play vital roles in organ damage following severe sepsis [3,4], and low oxygen delivery is related to patient death [5]. Hypoxia can directly damage the cellular function and destroy the cellular structure, which is the major pathological basis of sepsis-related MODS and death.…”

Circulating dipeptidyl peptidase-3 at admission is associated with circulatory failure, acute kidney injury and death in severely ill burn patients

“…The C index of DPP3 admin for 90-day mortality was 0.734 (0.653-0.815, p < 0.0001, standardized HR 2.6 (1.9-3.6)). DPP3 admin added prognostic value on top of ABSI (added chi 2 24.5, p < 0.0001), SOFA score at admission (SOFA admin , added chi 2 15.4, p < 0.0001), and lactate at admission (added chi 2 11.7, p = 0.0006) to predict 90-day mortality (Fig. 2).…”

“…DPP3 admin was associated with circulatory failure with an AUC of 0.680 (0.581-0.778, p < 0.0001, standardized OR 2.8 (1.6-4.9)). DPP3 admin provided value on top of ABSI (added chi 2 12.2, p = 0.0005), SOFA score at admission (SOFA admin , added chi 2 4.9, p = 0.0268), and lactate at admission (added chi 2 6.9, p = 0.0086) to predict hemodynamic support in the first 48 h. There was no correlation between DPP3 and the volume administered on day 1 (r = 0.17, p = 0.07).…”

“…Severe burn injury is associated with an early and profound hypovolemia followed by an intense systemic inflammatory response. Hemodynamic management, including fluid resuscitation, has long been recognized as the cornerstone of the early management and hemodynamic resuscitation of severely burned patients [1][2][3]. However, a systemic inflammatory response may be associated with distributive shock and/or acute myocardial dysfunction [4].…”