Adequate fluid resuscitation decreases incidence of acute renal failure in burn patients
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Abstract
Burns constitute a severe health problem in many countries. In Indonesia burns rank 4th of all trauma-related diseases and are a burden on the country’s health system. Adequate fluid resuscitation is the initial management of burns that determines the success of treatment. This study aimed to determine the relationship between adequate fluid resuscitation and incidence of acute renal failure in burn patients.
METHODS
A retrospective study of cross-sectional design was conducted on 30 burn patients who came to the Emergency Unit (ER) from January 2015-December 2017. Medical records were reviewed to examine the data on fluid resuscitation according to the Parkland formula and the laboratory data. Acute renal failure was defined as a creatinine level of more than 2.1 mg/dL after 7 days. Hypoalbuminemia was defined as an albumin level of less than 3.4 g/dL. Fisher’s exact test was used to analyze the data.
RESULTS
Twenty-two subjects received fluid resuscitation according to the Parkland formula and 8 did not. Twenty-five experienced complications such as acute renal failure (ARF) (13.3%), hypoalbuminemia (46.7%) and a combination of ARF and hypoalbuminemia (23.3%). One person died. Adequate fluid resuscitation was significantly associated with decrease incidence of ARF (p=0.015), but not significantly with hypoalbuminemia (p=0.214) and with mortality (p=0.267).
CONCLUSION
Adequate fluid resuscitation decreased the incidence of ARF in burn patients. Consensus protocols for initial burn resuscitation and treatment are crucial to avoid the consequences of ARF after burn injury.
Article Details
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References
Yasti AC, Senel E, Saydam M, et al. Guideline and treatment algorithm for burn injuries. Turk J Trauma Emerg Surg 2015;21:79-89. doi: 10.5505/tjtes.2015.88261.
Wardhana A, Basuki A, Prameswara ADH, et al. The epidemiology of burns in Indonesia’s national referral burn center from 2013 to 2015. Burns Open 2017;1:67–73. DOI: https://doi.org/10.1016/j.burnso.2017.08.002.
World Health Organization. Global health estimates 2016: disease burden by cause, age, sex, by country and by region, 2000-2016. Geneva: World Health Organization; 2018.
Martina NR, Wardhana A. Mortality analysis of adult burn patients. J Plast Rekonstr 2013;2:497–524. DOI: https://doi.org/10.14228/155.
Van der Merwe AE, Steenkamp WC. Prevention of burns in developing countries. Ann Burns Fire Disasters 2012;25:188-91.
World Health Organzation. WHO health estimates 2014 summary tables: deaths and global burden of disease. Geneva : World Health Organzation;2014.
Pujisriyani, Wardana A. Epidemiology of burn Injuries in Cipto Mangunkusumo Hospital from 2009 to 2010. J Plast Rekonstruksi 2012;1:528-31. DOI: https://doi.org/10.14228/110.
Hidayat TSN, Noer MS. Five years retrospective study of burns in Dr. Soetomo General Hospital Surabaya. J Rekonstr Estet 2013;1:123-30.
Sánchez-Sánchez M, Garcia-de-Lorenzo A, Cachafeiro L, et al. Acute kidney injury in critically burned patients resuscitated with a protocol that includes low doses of hydroxyethyl starch. Ann Burns Fire Disasters 2016; 29:183–8.
Michael J, Tam N, Matthew B, et al. Early acute kidney injury predicts progressive renal dysfunction and higher mortality in severely burned adults. J Burn Care Res 2010;31:83–92. doi: 10.1097/BCR.0b013e3181cb8c87.
Wu G, Xiao Y, Wang C, et al. Risk factors for acute kidney injury in patients with burn injury: a meta-analysis and systematic review. J Burn Care Res 2017;38:271-82. doi: 10.1097/BCR.0000000000000438.
Clark A, Neyra J, Madni T, et al. Acute kidney injury after burn. Burns 2017;43:898-908. DOI: https://doi.org/10.1016/j.burns.2017.01.023.
Coca SG, Bauling P, Schifftner T, et al. Contribution of acute kidney injury toward morbidity and mortality in burns: a contemporary analysis. Am J Kidney Dis 2008;49:517-23.
Kumar AB, Andrews W, Shi Y, et al. Fluid resuscitation mediates the association between inhalational burn injury and acute kidney injury in the major burn population. J Crit Care 2017;38:62-67. doi: 10.1016/j.jcrc.2016.10.008.
Thalji SZ, Kothari AN, Kuo PC, et al. Acute kidney injury in burn patients: clinically significant over the initial hospitalization and 1 year after injury: an original retrospective cohort study. Ann Surg 2017;266:376–82. doi: 10.1097/SLA.0000000000001979.
Schneider DF, Dobrowolsky A, Shakir IA, et al. Predicting acute kidney injury among burn patients in the 21st century: a classification and regression tree analysis. J Burn Care Res 2012;33:242-51. doi: 10.1097/BCR.0b013e318239cc24.
International Society of Nephrology. Guidelines – KDIGO. Kidney disease improving global outcomes (KDIGO). Kidney International Supplements 2017;7:1–59.
Wardhana A, Hardya H, Rezza M. Parkland formula vs restricted fluid in burn resucitation a systematic review of cohort studies. Critical Care Med 2018;46:34. doi: 10.1097/01.ccm.0000528323.46970.09.
Watkins SC, Shaw AD. Fluid resuscitation for acute kidney injury: an empty promise. Curr Opin Crit Care 2016;22:527–32. doi: 10.1097/MCC.0000000000000363.
Pérez-Guisado J, de Haro-Padilla JM, Rioja LF, et al. Serum albumin levels in burn people are associated to the total body surface burned and the length of hospital stay but not to the initiation of the oral/enteral nutrition. Int J Burns Trauma 2013;3:159–63.
Becerra OAA, Garibay CT, Amezcua MDM, et al. Serum albumin level as a risk factor for mortality in burn patients. Clinics (Sao Paulo) 2013;68:940-5. doi: 10.6061/clinics/2013(07)09.