Clinical Challenges in Burn Surgery: Burn Resuscitation - Titrating and Troubleshooting - Part 2 of 2

A patient with a large TBSA burn injury is transferred to a regional burn center. You are faced with some difficult clinical decisions as the resuscitation proves to be challenging. Join Drs. Tam Pham, Rob Cartotto, Julie Rizzo, Alex Morzycki and Jamie Oh as they discuss the clinical challenges in titrating and troubleshooting during acute burn resuscitation.

Hosts:
· Dr. Tam Pham: UW Medicine Regional Burn Center
· Dr. Robert Cartotto: University of Toronto, Ross Tilley Burn Centre
· Dr. Julie Rizzo: Brooke Army Medical Center
· Dr. Alex Morzycki: UW Medicine Regional Burn Center
· Dr. Jamie Oh: UW Medicine Regional Burn Center

Learning Objectives:
· Understand the role of colloids as complement/rescue to standard crystalloid fluid titration.
· Identify the fluid threshold associated with development of abdominal compartment syndrome
· Understand the role of continuous renal replacement therapy for patients with acute kidney injury during the resuscitation phase.
· List specific patient populations who may experience a more difficult resuscitation.

References:

1. Ivy ME, Atweh NA, Palmer J, et al. Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma 2000
https://pubmed.ncbi.nlm.nih.gov/11003313/
2. Cartotto R, Johnson LS, Savetamal A, et al. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. J Burn Care Res 2023
https://pubmed.ncbi.nlm.nih.gov/38051821/
3. Greenhalgh DG, Cartotto R, Taylor SL, et al. Burn Resuscitation practices in North America: results of the Acute Burn ResUscitation Prospective Trial (ABRUPT). Ann Surg 2023
https://pubmed.ncbi.nlm.nih.gov/34417368/
4. Cartotto R, Callum J. A review of the use of human albumin in burn patients. J Burn Care Res 2012
https://pubmed.ncbi.nlm.nih.gov/23143614/
5. Cruz MV, Carney BC, Luker JN, et al. Plasma ameliorates endothelial dysfunction in burn injury. J Surg Res 2019
https://pubmed.ncbi.nlm.nih.gov/30502286/
6. Falhstrom K, Boyle C, Makic MBF. Implementation of a nurse-driven burn resuscitation protocol: a quality improvement project. Critical Care Nurses 2013
https://pubmed.ncbi.nlm.nih.gov/23377155/
7. Salinas J, Chung KK, Mann EA, et al. Computerized decision support system improves fluid resuscitation following severe burns: an original study. Crit Care Med 2011
https://pubmed.ncbi.nlm.nih.gov/21532472/
8. Kenney CL, Singh P, Rizzo J, et al. Impact of alcohol and methamphetamine use on burn resuscitation. J Burn Care Res 2023
https://pubmed.ncbi.nlm.nih.gov/37227949/

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