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- Title
T1 Initial Results of the American Burn Association (ABA) Multi-Center Evaluation on the Effectiveness of the Burn Navigator.
- Authors
Rizzo, Julie A; Serio-Melvin, Maria L; Coates, Elsa; Liu, Nehemiah T; Salinas, Jose
- Abstract
Introduction The Burn Navigator (BN) is an FDA-cleared clinical decision support tool used to aid fluid resuscitation after major burn injury. The BN provides users with hourly recommendations for fluid titration during the initial resuscitation based on various factors. The objective of this multi-center observational study was to evaluate the resuscitation volumes and related outcomes of patients admitted to five ABA verified burn centers who underwent intravenous fluid resuscitation utilizing the BN. Methods Data was collected from 300 patients who were resuscitated utilizing the BN. Two analyses were performed: examination of the first 24 hours of resuscitation after burn injury and examination of 24 hours of resuscitation using the BN, regardless of when the resuscitation began, to account for patients who presented in a delayed fashion. Patients were classified as having followed the BN device if all hourly fluid rates were within 40 mL of the BN recommendations (20 mL above or below) for that hour at least 75% of the time. Results For 285 patients, average age, weight, and TBSA were 45.6 ± 16.8 years, 87.0 ± 22.8 kg, and 39.0 ± 17.8%, with partial/full thickness percentages of 22.2 ± 15.2% and 17.0 ± 19.7%, respectively. Analysis of 286 patients in the first 24 hours of resuscitation revealed an average of 4.07 ± 1.76 mL/kg/TBSA and 151.48 ± 77.46 mL/kg of primary crystalloid fluid. When considering all fluids administered to include colloids and medications, enteral and oral feeds, and oral resuscitation fluids, average volumes in the first 24 hours were 4.68 ± 2.06 mL/kg/TBSA and 175.01 ± 92.22 mL/kg. To account for delayed presentation after burn injury, examining 24 hours of resuscitation regardless of the initiation of resuscitation, average volumes for primary and total fluids were 5.28 ± 2.54 mL/kg/TBSA, 201.11 ± 106.53 mL/kg, 6.35 ± 2.95 mL/kg/TBSA and 244.08 ± 133.5 mL/kg respectively. There was a significant decrease incidence of shock in the BN-guided group versus the non-BN-guided group (p< 0.05). Conclusions The Burn Navigator provides comparable resuscitation volumes of primary crystalloid fluid to the Parkland Formula. When all fluids are considered, the BN device recommends total fluid infusion less than the Ivy Index (250 mL/kg/24 hrs) and was associated with a decreased incidence of shock. Early initiation of the BN device resulted in lower overall fluid volumes during the first 24 hours of resuscitation.
- Subjects
UNITED States. Food &; Drug Administration; BURN care units; FLUID therapy; SALIVA; INTRAOSSEOUS infusions; EXPLORERS; COLLOIDS; RESUSCITATION
- Publication
Journal of Burn Care & Research, 2021, Vol 42, pS1
- ISSN
1559-047X
- Publication type
Article
- DOI
10.1093/jbcr/irab032.000