Revision of an Adult Burn Center’s Resuscitation Guideline Leads to Lower Resuscitation Requirements

Abstract In 2018, the institutional burn resuscitation guideline was updated to remove the use of high-dose ascorbic acid (HDAA) therapy, to lower 24-hour resuscitation fluid estimations from 4 to 2 mL/kg/TBSA, and to optimize guidance around appropriate colloid resuscitation. This retrospective study compared the incidence of a composite safety outcome (acute kidney injury, or intra-abdominal hypertension requiring intervention) between the pre-guideline update to post-guideline update. Secondarily, 24-hour resuscitation volumes, hourly urine output, vasopressor use, and mechanical ventilation duration were compared as well. The composite safety outcome was similar between the 2 groups (40% vs 29%; P = .27), but the post-group showed significantly lower 24-hour resuscitation volumes (3.74 vs 2.94 mL/kg/TBSA; P .01), as well as lower urine output (1.26 vs 0.75 mL/kg/h; P .01). There was no difference between the groups with respect to vasopressor use, mechanical ventilation duration, or mortality. This study suggests that a simplified resuscitation protocol without HDAA, combined with a lower starting fluid rate, led to significantly lower 24-hour resuscitation volumes without an increase in adverse safety events.