Email Alerts
RSS
Volume 40 Issue 11
Nov.  2024
Turn off MathJax
Article Contents
Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2024  >  40(11): 1024-1033
Huang SY,Ma QM,Wang YS,et al.A multicenter study on the impact of the early infusion rate on prognosis and the factors of influencing the infusion rate in patients with severe burns and inhalation injury[J].Chin J Burns Wounds,2024,40(11):1024-1033.DOI: 10.3760/cma.j.cn501225-20240409-00130.
Citation: Huang SY,Ma QM,Wang YS,et al.A multicenter study on the impact of the early infusion rate on prognosis and the factors of influencing the infusion rate in patients with severe burns and inhalation injury[J].Chin J Burns Wounds,2024,40(11):1024-1033.DOI: 10.3760/cma.j.cn501225-20240409-00130.
shu

A multicenter study on the impact of the early infusion rate on prognosis and the factors of influencing the infusion rate in patients with severe burns and inhalation injury

doi: 10.3760/cma.j.cn501225-20240409-00130
  • 1.

    Medical Center of Burn Plastic and Wound Repair, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang330006, China

  • 2.

    Department of Critical Care Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai200120, China

  • 3.

    Department of Burn Trauma and Wound Repair, the First Affiliated Hospital of Naval Medical University, Shanghai200433, China

  • 4.

    Department of Burns and Plastic Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou510220, China

  • 5.

    Department of Burns, Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital, Wuhan430060, China

  • 6.

    Department of Burns and Plastic Surgery, the 924th Hospital of PLA, Guilin541002, China

  • 7.

    Department of Burns and Plastic Surgery, the Fourth People's Hospital of Dalian, Dalian116031, China

  • 8.

    Department of Burns, Zhengzhou First People's Hospital, Zhengzhou450004, China

Funds:

National Key Research and Development Program 2019YFA0110601

Shanghai Pudong New Area Summit Construction Project PWYgf2021-03

More Information
    Abstract
  •   Objective  To investigate the impact of the early infusion rate on prognosis and the factors of influencing the infusion rate in patients with severe burns and inhalation injury.  Methods  This study was a retrospective case series research. From January 2015 to December 2020, 220 patients with severe burns and inhalation injury meeting the inclusion criteria were admitted to 7 burn treatment centers in China, including 13 cases in the Fourth People's Hospital of Dalian, 26 cases in the First Affiliated Hospital of Naval Medical University, 73 cases in Guangzhou Red Cross Hospital of Jinan University, 21 cases in the 924th Hospital of PLA, 30 cases in the First Affiliated Hospital of Jiangxi Medical College of Nanchang University, 30 cases in Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital, and 27 cases in Zhengzhou First People's Hospital. There were 163 males and 57 females, and their ages ranged from 18 to 91 years. The patients were divided into survival group and death group according to the survival within 28 d post injury. The following data of patients in the 2 groups were collected, including basic information (gender, age, body weight, body temperature, etc.), the injury characteristics (total burn area, post-injury admission time, etc.), the underlying diseases, the post-injury fluid resuscitation condition (infusion rate and ratio of infused electrolyte solution to colloid solution in the first 24 h post injury, etc.), the results of laboratory tests on admission (blood urea nitrogen, blood creatinine, albumin, pH value, base excess, blood lactate, oxygenation index, etc.), and treatment condition (inhaled oxygen volume fraction, hospitalization day, renal replacement therapy, etc.). After adjusting covariates using univariate Cox regression analysis, the multivariate Cox regression analysis was performed to evaluate the impact of infusion rate in the first 24 h post injury on patient death. The receiver operator characteristic curve for the infusion rate in the first 24 h post injury to predict the risk of death was plotted, and the maximum Youden index was calculated. Patients were divided into 2 groups according to the cutoff value (2.03 mL·kg-1·% total body surface area (TBSA)-1) for predicting risk of death by the infusion rate in the first 24 h post injury determined by the maximum Youden index, and the risk of death was compared between the 2 groups. The correlation between the previously mentioned clinical data and the infusion rate in the first 24 h post injury was analyzed; after the univariate linear regression analysis was used to screen the independent variables, the multivariate linear regression analysis was performed to screen the independent influential factors on the infusion rate in the first 24 h post injury.  Results  Compared with those in survival group, patients in death group had significantly higher age and total burn area (with Z values of 12.08 and 23.71, respectively, P<0.05), the infusion rate in the first 24 h post injury, inhaled oxygen volume fraction, and blood urea nitrogen, blood creatinine, blood lactic acid on admission (with Z values of 7.99, 4.01, 11.76, 23.24, and 5.97, respectively, P<0.05), and the proportion of patients treated with renal replacement therapy (P<0.05) were significantly higher, the albumin, pH value, and base excess on admission were significantly lower (t=2.72, with Z values of 8.18 and 9.70, respectively, P<0.05), and the hospitalization day was significantly reduced (Z=85.47, P<0.05). After adjusting covariates, the infusion rate in the first 24 h post injury was the independent influential factor on death (with standardized hazard ratio of 1.69, 95% confidence interval of 1.21-2.37, P<0.05). Patients in infusion rate ≥2.03 mL·kg-1·%TBSA-1 group had a significantly higher risk of death than those in infusion rate <2.03 mL·kg-1·% TBSA-1 group (with hazard ratio of 3.47, 95% confidence interval of 1.48-8.13, P<0.05). There was a significant correlation between total burn area, body weight, inhaled oxygen volume fraction, body temperature, post-injury admission time, the ratio of infused electrolyte solution to colloid solution in the first 24 h post injury, and oxygenation index <300 on admission and the infusion rate in the first 24 h post injury (with r values of -0.192, -0.215, 0.137, -0.162, -0.252, and 0.314, respectively, Z=4.48, P<0.05). After screening the independent variables, total burn area, body weight, post-injury admission time, and oxygenation index <300 on admission were the independent influential factors on the infusion rate in the first 24 h post injury (with standardized β values of -0.22, -0.22, -0.19, and 0.46, respectively, 95% confidence intervals of -0.34 to 0.09, -0.34 to 0.10, -0.32 to 0.06, and 0.22 to 0.71, respectively, P<0.05).  Conclusions  The infusion rate in the first 24 h post injury in patients with severe burns and inhalation injury is the independent factor of influencing death, and patients with infusion rate ≥2.03 mL·kg-1·%TBSA-1 in the first 24 h post injury have a significantly increased risk of death. The total burn area, body weight, post-injury admission time, and oxygenation index <300 on admission were the independent factors of influencing the infusion rate in the first 24 h post injury in patients with severe burns and inhalation injury.

     

    • FullText(HTML)
  • loading
    • References(34)
  • [1]
    HodgmanEI,SubramanianM,ArnoldoBD,et al.Future therapies in burn resuscitation[J].Crit Care Clin,2016,32(4):611-619.DOI: 10.1016/j.ccc.2016.06.009.
    [2]
    MercelA,TsihlisND,MaileR,et al.Emerging therapies for smoke inhalation injury: a review[J].J Transl Med,2020,18(1):141.DOI: 10.1186/s12967-020-02300-4.
    [3]
    DyamenahalliK,GargG,ShuppJW,et al.Inhalation injury: unmet clinical needs and future research[J].J Burn Care Res,2019,40(5):570-584.DOI: 10.1093/jbcr/irz055.
    [4]
    ShahA,PedrazaI,MitchellC,et al.Fluid volumes infused during burn resuscitation 1980-2015: a quantitative review[J].Burns,2020,46(1):52-57.DOI: 10.1016/j.burns.2019.11.013.
    [5]
    DittrichM,HosniND,de CarvalhoWB.Association between fluid creep and infection in burned children: a cohort study[J].Burns,2020,46(5):1036-1042.DOI: 10.1016/j.burns.2020.02.003.
    [6]
    SaffleJR.Fluid creep and over-resuscitation[J].Crit Care Clin,2016,32(4):587-598.DOI: 10.1016/j.ccc.2016.06.007.
    [7]
    PayneML,YoungS,HeardJ,et al.Effect of dexmedetomidine on fluid resuscitation in burn-injured patients[J].J Burn Care Res,2024,45(5):1257-1263.DOI: 10.1093/jbcr/irae038.
    [8]
    BasasVA,SchutzmanLM,BrownIE.Implications of the regulation of endothelial glycocalyx breakdown and reconstitution in severe burn injury[J].J Surg Res,2023,286:110-117.DOI: 10.1016/j.jss.2022.12.033.
    [9]
    中国老年医学学会烧创伤分会.吸入性损伤临床诊疗全国专家共识(2018版)[J].中华烧伤杂志,2018,34(11):770-775.DOI: 10.3760/cma.j.issn.1009-2587.2018.11.010.
    [10]
    KimJH.Multicollinearity and misleading statistical results[J].Korean J Anesthesiol,2019,72(6):558-569.DOI: 10.4097/kja.19087.
    [11]
    AdamantosS.Fluid therapy in pulmonary disease: how careful do we need to be?[J].Front Vet Sci,2021,8:624833.DOI: 10.3389/fvets.2021.624833.
    [12]
    潘泽平,荆银磊,李明,等.吸入性损伤对大面积烧伤患者休克期液体复苏的影响[J].中华烧伤杂志,2020,36(5):370-377.DOI: 10.3760/cma.j.cn501120-20191204-00452.
    [13]
    HughesKR,ArmstrongRF,BroughMD,et al.Fluid requirements of patients with burns and inhalation injuries in an intensive care unit[J].Intensive Care Med,1989,15(7):464-466.DOI: 10.1007/BF00255603.
    [14]
    DanielsM,FuchsPC,LeferingR,et al.Is the Parkland formula still the best method for determining the fluid resuscitation volume in adults for the first 24 hours after injury? - A retrospective analysis of burn patients in Germany[J].Burns,2021,47(4):914-921.DOI: 10.1016/j.burns.2020.10.001.
    [15]
    FosterKN,CarusoDM.Fluid resuscitation in burn patients: current care and new frontiers[J].Crit Care Clin,2016,32(4):xv-xvi.DOI: 10.1016/j.ccc.2016.07.001.
    [16]
    HunterJE,DrewPJ,PotokarTS,et al.Albumin resuscitation in burns: a hybrid regime to mitigate fluid creep[J].Scars Burn Heal,2016,2:2059513116642083.DOI: 10.1177/2059513116642083.
    [17]
    LegrandM,ClarkAT,NeyraJA,et al.Acute kidney injury in patients with burns[J].Nat Rev Nephrol,2024,20(3):188-200.DOI: 10.1038/s41581-023-00769-y.
    [18]
    LangTC,ZhaoR,KimA,et al.A critical update of the assessment and acute management of patients with severe burns[J].Adv Wound Care (New Rochelle),2019,8(12):607-633.DOI: 10.1089/wound.2019.0963.
    [19]
    CartottoR,JohnsonLS,SavetamalA,et al.American Burn Association clinical practice guidelines on burn shock resuscitation[J].J Burn Care Res,2024,45(3):565-589.DOI: 10.1093/jbcr/irad125.
    [20]
    WareLB,MatthayMA.Alveolar fluid clearance is impaired in the majority of patients with acute lung injury and the acute respiratory distress syndrome[J].Am J Respir Crit Care Med,2001,163(6):1376-1383.DOI: 10.1164/ajrccm.163.6.2004035.
    [21]
    HuβmannB,LeferingR,TaegerG,et al.Influence of prehospital fluid resuscitation on patients with multiple injuries in hemorrhagic shock in patients from the DGU trauma registry[J].J Emerg Trauma Shock,2011,4(4):465-471.DOI: 10.4103/0974-2700.86630.
    [22]
    VignonP,EvrardB,AsfarP,et al.Fluid administration and monitoring in ARDS: which management?[J].Intensive Care Med,2020,46(12):2252-2264.DOI: 10.1007/s00134-020-06310-0.
    [23]
    PalmerL.Fluid management in patients with trauma: restrictive versus liberal approach[J].Vet Clin North Am Small Anim Pract,2017,47(2):397-410.DOI: 10.1016/j.cvsm.2016.10.014.
    [24]
    GilCano A,Gracia RomeroM,MongeGarcía MI,et al.Preemptive hemodynamic intervention restricting the administration of fluids attenuates lung edema progression in oleic acid-induced lung injury[J].Med Intensiva,2017,41(3):135-142.DOI: 10.1016/j.medin.2016.08.008.
    [25]
    GiretzlehnerM,DirnbergerJ,OwenR,et al.The determination of total burn surface area: how much difference?[J].Burns,2013,39(6):1107-1113.DOI: 10.1016/j.burns.2013.01.021.
    [26]
    BittnerE,SheridanR.Acute respiratory distress syndrome, mechanical ventilation, and inhalation injury in burn patients[J].Surg Clin North Am,2023,103(3):439-451.DOI: 10.1016/j.suc.2023.01.006.
    [27]
    GiovanniSP,SeitzKP,HoughCL.Fluid management in acute respiratory failure[J].Crit Care Clin,2024,40(2):291-307.DOI: 10.1016/j.ccc.2024.01.004.
    [28]
    LeeJ,CorlK,LevyMM.Fluid therapy and acute respiratory distress syndrome[J].Crit Care Clin,2021,37(4):867-875.DOI: 10.1016/j.ccc.2021.05.012.
    [29]
    LiX,ZhangQ,ZhuY,et al.Effect of perioperative goal-directed fluid therapy on postoperative complications after thoracic surgery with one-lung ventilation: a systematic review and meta-analysis[J].World J Surg Oncol,2023,21(1):297.DOI: 10.1186/s12957-023-03169-5.
    [30]
    KanCFK,SkaggsJD.Current commonly used dynamic parameters and monitoring systems for perioperative goal-directed fluid therapy: a review[J].Yale J Biol Med,2023,96(1):107-123.DOI: 10.59249/JOAP6662.
    [31]
    TejiramS,TranchinaSP,TravisTE,et al.The first 24 hours: burn shock resuscitation and early complications[J].Surg Clin North Am,2023,103(3):403-413.DOI: 10.1016/j.suc.2023.02.002.
    [32]
    中国老年医学学会烧创伤分会.烧伤休克防治全国专家共识(2020版)[J].中华烧伤杂志,2020,36(9):786-792.DOI: 10.3760/cma.j.cn501120-20200623-00323.
    [33]
    ISBI Practice Guidelines Committee,SubcommitteeSteering,SubcommitteeAdvisory.ISBI practice guidelines for burn care[J].Burns,2016,42(5):953-1021.DOI: 10.1016/j.burns.2016.05.013.
    [34]
    EljaiekR,HeylbroeckC,DuboisMJ.Albumin administration for fluid resuscitation in burn patients: a systematic review and meta-analysis[J].Burns,2017,43(1):17-24.DOI: 10.1016/j.burns.2016.08.001.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(3)  / Tables(7)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (88) PDF downloads(7) Cited by()
    Proportional views
    Related

    Copyright © Chinese Journal of Burns京ICP备07035254号-14

    E-mail：shaoshangzazhi@163.com

    Website：https://zhsszz.xml-journal.net/

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return