Precision Metrics for Driving Open- and Closed-Loop Resuscitation Algorithms for Enteral and IV Resuscitation in Burn Casualties
Abstract
Formula-driven burn resuscitation may deliver too much fluid resulting in significant comorbidities. An alternative strategy could be the use of enteral fluid resuscitation, which has been explored for decades. In line with this, recent fluid therapy recommendations from the prolonged field care working group only mention in brief that enteral fluids have been studied in burns up to 40 percent TBSA. In fact, while enteral fluids have been shown to reduce the volumes of IV fluids given, there is a paucity of information regarding fluid type, volumes, and efficacy. A recent randomized controlled trial continues to advocate for oral rehydration post-burn, but this strategy has largely been forgotten by current practice. In short, the need exists for a new personalized approach that incorporates new targets and endpoints for identifying which patients respond to resuscitation (both IV and enteral) versus those that do not. Burn resuscitation is not an exact science, and experienced providers supplement UO with static physiologic measurements (e.g., blood pressure, pulmonary arterial occlusion pressure, cardiac index, etc.). For IV resuscitation, a decision support system based on burn surface area and UO was developed at USAISR and has become commercially available. Both these static measurements as well as the dynamic ones listed above (PPV, SPV, SVV) could be incorporated into existing decision support system algorithms for identifying which patents respond to both enteral and IV fluids. The current proposal will characterize burn-induced changes in functional hemodynamic variables to determine new endpoints that will guide IV and enteral resuscitation.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jan 01, 2023
- Accession Number
- AD1199646
Entities
People
- David M Burmeister
Organizations
- Geneva Foundation