Reducing Fluid Resuscitation through a nurse titrated Protocol

Ms Jing Hui Loh1, Dr Xi Wern Loh1, Dr  Vui Kian Ho1, A.Prof. Si Jack Chong1

1Singapore General Hospital, Singapore, Singapore

Introduction: Fluid creep is a significant problem in the resuscitation of burn patients and has been linked to increased morbidity and mortality. Parkland formula may contribute to fluid creep. We hypothesized that a nurse-titrated fluid protocol would reduce the amount of fluids given to burn patients while avoiding adverse outcomes due to under-resuscitation.

Methods: Adult patients  with >15% total body surface area (TBSA) burns admitted of our institution within 24 hours of injury from Oct15 to Apr17 were enrolled in a prospective observational study. Patients were commenced on a fluid resuscitation of 3ml/kg/%BSA in the first 24 hours, with half of the volume to be infused in the first 8 hours. 5% albumin was added at a rate of 0.4ml/kg/%BSA/16h. The infusion rate was titrated to maintain a mean arterial pressure of >60mmHg and a urine output of 0.4-0.6ml/kg/h.

Results: 22 patients with a mean age of 36.6 years and a mean TBSA of 33.5% TBSA were included in the study. 6 (27%) were admitted to ICU. Mean volume of fluids given was 6334ml, a statistically significant 27.6% reduction compared to the mean predicted fluid volume of 9192ml based on Parkland formula (p=0.001). The mean number of intervention points per patient was 1.96.  8 patients had at least 1 episode of oliguria but no cases of AKI, ACS or need for RRT.

Conclusion: A nurse titrated fluid resuscitation protocol for burn patients was practicable, safe and effective in reducing fluid volumes required for resuscitation without an increase in secondary complications.

Ms Loh Jinghui has been instrumental in competing this study and presented the preliminary report to enthusiastic audience in Taipei in Apr 2017. Dr Chong SJ as PI and mentor is presenting her work at this conference

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