An Adjusted Ideal Body Weight Index Formula With Fresh Frozen Plasma (FFP) Rescue Decreases Fluid Creep During Burn Resuscitation

L Lindsey; M V Purvis; D Miles; A Lintner; V Scott; K McGinn; A Bright; S A Kahn

An Adjusted Ideal Body Weight Index Formula With Fresh Frozen Plasma (FFP) Rescue Decreases Fluid Creep During Burn Resuscitation

Ann Burns Fire Disasters. 2020 Sep 30;33(3):216-223.

Authors

L Lindsey¹, M V Purvis², D Miles³, A Lintner², V Scott², K McGinn⁴, A Bright², S A Kahn⁵

Affiliations

¹ School of Medicine, University of South Alabama, Mobile, AL, USA.
² Department of Surgery, Division of Acute Care Surgery & Burns, The University of South Alabama Medical Center, Mobile, AL, USA.
³ School of Medicine, University of Mississippi, Jackson, MS, USA.
⁴ Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, Mobile, AL, USA.
⁵ Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.

PMID: 33304212
PMCID: PMC7680196

Abstract
in English, French

Severe burn injury requires significant volume resuscitation, but over-resuscitation can be deadly. Accurate resuscitation of obese patients is challenging due to the decreased vascularity of adipose tissue. This study compares an adjusted ideal body weight index formula with fresh frozen plasma rescue to historical controls resuscitated with Parkland-based resuscitation. A retrospective review was conducted of adult patients admitted to our regional burn center with ≥ 20% total body surface area (TBSA) burns from 2010 to 2017 who survived more than 48 hours. Historical controls were resuscitated with Parkland-based resuscitation with occasional albumin. The adjusted ideal body weight (AIBW) patients were resuscitated with 2-4 mL/kg/%TBSA using an adjusted ideal body weight with fresh frozen plasma (FFP) rescue. Outcomes were compared with nonparametric statistics. A total of 161 patients met inclusion criteria: 40 patients received AIBW resuscitation and 121 patients were included as controls. The AIBW group received less fluid (3.30 vs. 4.15 mL/kg/%TBSA, p<0.001). A significant reduction in acute kidney injury requiring dialysis in the AIBW group was appreciated (5% vs. 19%, p=0.03) with improved mortality in AIBW patients as well (5% vs. 20%, p=0.03). Using an adjusted ideal body weight with FFP rescue to resuscitate patients with severe burn injury leads to a significant reduction in fluid administration without increase in acute kidney injury requiring dialysis and with improved mortality.

Les brûlés graves ont besoin d’un remplissage vasculaire majeur, pouvant toutefois être mortel s’il est exagéré. Il est particulièrement difficile chez les obèses, en raison de la faible vascularisation du tissu adipeux. Cette étude compare une formule basée sur le poids idéal (PI) et utilisant du PFC à des séries historiques utilisant la formule de Parkland. Cette étude rétrospective a revu les dossiers des patients admis dans notre CTB, ayant survécu plus de 48 h, entre 2010 et 2017. Les 121 cas historiques recevaient un remplissage selon Parkland (et de l’albumine au besoin). Les 40 patients à l’étude recevaient 2 à 4 mL/kg/% de PFC, le volume étant calculé sur le poids idéal. Ce groupe recevait significativement (p < 0,001) moins (3,3 mL/kg/%) de volume que le groupe contrôle (4,15). Ils avaient aussi moins fréquemment besoin d’épuration extra- rénale (5% VS 19%, p= 0,03) et leur mortalité était moindre (5% VS 20%, p= 0,03).

Keywords: adjusted ideal body weight; burn; fresh frozen plasma; obesity; resuscitation.

Abstract in English, French

Abstract
in English, French