Far-Forward, Fluid First, (4F) Enteral Resuscitation (EnteroResus) for Moderate-Size Burns (20%-40% TBSA): A Hybrid Type I Effectiveness-Implementation Study
Abstract
Patients with serious burns require fluid to prevent dehydration, organ failure, and death. Fluid for burns is typically given intravenously (IV), or directly into the blood. However, Soldiers on the battlefield and others injured in austere places frequently do not receive sufficient amounts of fluid early enough because IV fluid administration (resuscitation) is complicated and requires advanced resources. A simpler, more operationally advantageous strategy for burn resuscitation is urgently needed to improve the short- and long-term outcomes of people burned in austere places (e.g., the battlefield, rural U.S., developing countries). Giving fluid by mouth or through a feeding tube placed through the nose into the stomach (routinely placed to supplement nutrition in seriously burned patients) to prevent or treat dehydration is called enteral resuscitation. Enteral resuscitation is commonly performed around the world for children and adults with diarrhea. Enteral resuscitation has been performed for children and adults with burns but has not been directly compared to IV resuscitation. Enteral resuscitation is particularly attractive in the pre-hospital setting or during a Prolonged Field Care (PFC) scenario because it can be provided by the patient themselves (by drinking), by a non-medical first responder (by a buddy or bystander), or by a medical first responder (by a combat medic). The objectives of this study are to: (1) Compare the effectiveness of enteral resuscitation to IV resuscitation, and (2) Identify challenges and facilitators to implementing enteral resuscitation in austere places. We plan to study enteral resuscitation in Ghana, where burn injuries are common and often serious and where resources to care for patients with burn injuries are similar to the resources available to military medics. We anticipate that the findings from this study will have high impact and direct military benefit. For example, enteral resuscitation may: (1) reduce delays in pre-hospital resuscitation for injured soldiers on the battlefield, (2) change the standard of care for the resuscitation of burn injured soldiers to improve their short- and long-term outcomes; and (3) advance guidelines for military burn care. The findings will also have important implications for the early burn care and resuscitation of people burned in the rural U.S. and in developing countries, where 90% of all burn injuries occur. Our study is also designed so that we can obtain valuable information about the implementation of enteral resuscitation for burns in real-world settings. By doing so, we will be able to accelerate the uptake of enteral resuscitation, create more effective implementation strategies for other settings, and inform burn care training programs. We anticipate that, if effective, enteral resuscitation could be incorporated into practice guidelines with 2-4 years of study completion.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110364
Entities
People
- Barclay Stewart
Organizations
- United States Army
- University of Washington