Far-Forward, Fluid First, (4F) Enteral Resuscitation (EnteroResus) for Moderate-Size Burns (20%- 40% TBSA): A Hybrid Type I Effectiveness-Implementation Study
Abstract
Short- and long-term outcomes of soldiers and civilians with burn injuries are greatly impacted by the care provided in the first hours and days after injury,particularly fluid resuscitation.(1-3) Profoundinflammation-induced capillary leak syndrome (CLS) is a hallmark of moderate and severe burn injury.(4) If un- or under-treated, CLS results in dehydration, hypovolemic shock, wound progression, organ failure and death. Patients with burn injuries 10-20% total body surface area (TBSA) are typically resuscitated with intravenous(IV) fluids to prevent these sequelae. However, in austere settings, patients often present to medics, health posts, and first-level hospitals that do not have the resources to provide goal-directed IV fluid resuscitation.(5) To address the complexity of goal-directed IV fluid resuscitation while acknowledging resource constraints in LMICs, burn care experts have recommended implementation of enteral resuscitation-based protocols.(6-11) burn injured soldiers and civilians around the world. We plan to perform a hybrid effectiveness-implementation cluster-randomized controlled trial of enteral resuscitation to IV resuscitation in Ghana. The first and second years has been focused on developing materials (e.g., study protocol revisions, resuscitation protocols, documentation, educational/training materials, DSMB documents), navigating the labyrinth of US and Ghanaian regulatory bodies with conflicting priorities/perspectives (e.g., eligibility of children, safety of enteral resuscitation, role of IV fluids in the intervention clusters), establishing agreements and infrastructure to facilitate the project (e.g., sub-contracts, financial sharing platform), and bringing co-investigators and sites to speed on research operations.
Document Details
- Document Type
- Technical Report
- Publication Date
- Oct 01, 2023
- Accession Number
- AD1219007
Entities
People
- Barclay T. Stewart
Organizations
- University of Washington