Fluid Management as a Risk Factor for Intra-abdominal Compartment Syndrome in Burn Patients: A Total Body Surface Area-Independent Multicenter Trial Part I.

Fluid management is one of the anticipated risk factors for intra-abdominal compartment syndrome (ACS). Since fluid requirements depend on the burned total body surface area (TBSA), an independent analysis is necessary to adapt resuscitation protocols and prevent this life-threatening complication. A retrospective multicenter study with matched-pair analysis was conducted in four German burn centers, including 38 burn patients with ACS who underwent decompressive laparotomy. Potential risk factors were analyzed, such as resuscitation volume, total fluid intake, mean fluid administration per day, fluid balance, and blood transfusion. The ACS group and control were compared with a two-tailed Mann-Whitney U test (P < .05). The ACS group was split up into an early and late ACS group for statistical subgroup analysis. Total fluid intake, fluid balance, and the total volume of colloids showed no significant difference in the ACS group (mean TBSA 50%) versus control (mean TBSA 49%). The subgroup analysis showed significant higher total resuscitation volume, fluid administration per kilogram body weight, and fluid balance in the first 24 hours in the late-onset ACS group. This study shows a different risk factor profile for early-onset ACS in the first 4 days after trauma and late-onset ACS. Herein, fluid therapy is a fundamental risk factor for late-onset ACS. In early-onset ACS, fluid administration contributes significantly to the development of intra-abdominal hypertension, but other risk factors seem to turn the balance for the development of early-onset ACS in burn patients.

Electrical injury - a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors.

BACKGROUND: Electrical injuries represent life-threatening emergencies. Evidence on differences between high (HVI) and low voltage injuries (LVI) regarding characteristics at presentation, rhabdomyolysis markers, surgical and intensive burn care and outcomes is scarce. METHODS: Consecutive patients admitted to two burn centers for electrical injuries over an 18-year period (1998-2015) were evaluated. Analysis included comparisons of HVI vs. LVI regarding demographic data, diagnostic and treatment specific variables, particularly serum creatinine kinase (CK) and myoglobin levels over the course of 4 post injury days (PID), and outcomes. RESULTS: Of 4075 patients, 162 patients (3.9%) with electrical injury were analyzed. A total of 82 patients (50.6%) were observed with HVI. These patients were younger, had considerably higher morbidity and mortality, and required more extensive burn surgery and more complex burn intensive care than patients with LVI. Admission CK and myoglobin levels correlated significantly with HVI, burn size, ventilator days, surgical interventions, amputation, flap surgery, renal replacement therapy, sepsis, and mortality. The highest serum levels were observed at PID 1 (myoglobin) and PID 2 (CK). In 23 patients (14.2%), cardiac arrhythmias were observed; only 4 of these arrhythmias occurred after hospital admission. The independent predictors of mortality were ventilator days (OR 1.27, 95% CI 1.06-1.51, p = 0.009), number of surgical interventions (OR 0.47, 95% CI 0.27-0.834, p = 0.010) and limb amputations (OR 14.26, 95% CI 1.26-162.1, p = 0.032). CONCLUSIONS: Patients with electrical injuries, HVI in particular, are at high risk for severe complications. Due to the need for highly specialized surgery and intensive care, treatment should be reserved to burn units. Serum myoglobin and CK levels reflect the severity of injury and may predict a more complex clinical course. Routine cardiac monitoring > 24 h post injury does not seem to be necessary.