Hold the Pendulum: Rates of Acute Kidney Injury are Increased in Patients Who Receive Resuscitation Volumes Less than Predicted by the Parkland Equation Journal Article

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Authors: Mason, S. A.; Nathens, A. B.; Finnerty, C. C.; Gamelli, R. L.; Gibran, N. S.; Arnoldo, B. D.; Tompkins, R. G.; Herndon, D. N.; Jeschke, M. G.; Inflammation and the Host Response to Injury Collaborative Research Program.
Article Title: Hold the Pendulum: Rates of Acute Kidney Injury are Increased in Patients Who Receive Resuscitation Volumes Less than Predicted by the Parkland Equation
Abstract: OBJECTIVE: To determine whether restrictive fluid resuscitation results in increased rates of acute kidney injury (AKI) or infectious complications. BACKGROUND: Studies demonstrate that patients often receive volumes in excess of those predicted by the Parkland equation, with potentially detrimental sequelae. However, the consequences of under-resuscitation are not well-studied. METHODS: Data were collected from a multicenter prospective cohort study. Adults with greater than 20% total burned surface area injury were divided into 3 groups on the basis of the pattern of resuscitation in the first 24 hours: volumes less than (restrictive), equal to, or greater than (excessive) standard resuscitation (4 to 6 cc/kg/% total burned surface area). Multivariable regression analysis was employed to determine the effect of fluid group on AKI, burn wound infections (BWIs), and pneumonia. RESULTS: Among 330 patients, 33% received restrictive volumes, 39% received standard resuscitation volumes, and 28% received excessive volumes. The standard and excessive groups had higher mean baseline APACHE scores (24.2 vs 16, P lt; 0.05 and 22.3 vs 16, P lt; 0.05) than the restrictive group, but were similar in other characteristics. After adjustment for confounders, restrictive resuscitation was associated with greater probability of AKI [odds ratio (OR) 3.25, 95% confidence interval (95% CI) 1.18-8.94]. No difference in the probability of BWI or pneumonia among groups was found (BWI: restrictive vs standard OR 0.74, 95% CI 0.39-1.40, excessive vs standard OR 1.40, 95% CI 0.75-2.60, pneumonia: restrictive vs standard, OR 0.52, 95% CI 0.26-1.05; excessive vs standard, OR 1.12, 95% CI 0.58-2.14). CONCLUSIONS: Restrictive resuscitation is associated with increased AKI, without changes in infectious complications.
Journal Title: Annals of Surgery
Volume: 264
Issue: 6
ISSN: 1528-1140; 0003-4932
Publisher: Unknown  
Journal Place: United States
Date Published: 2016
Start Page: 1142
End Page: 1147
Language: eng
DOI/URL:

10.1097/SLA.0000000000001615
Notes: LR: 20170602; GR: U54 GM062119/GM/NIGMS NIH HHS/United States; GR: KL2 RR029875/RR/NCRR NIH HHS/United States; GR: KL2 TR001441/TR/NCATS NIH HHS/United States; GR: UL1 TR000071/TR/NCATS NIH HHS/United States; GR: R01 GM056687/GM/NIGMS NIH HHS/United States; GR: P50 GM060338/GM/NIGMS NIH HHS/United States; GR: T32 GM008256/GM/NIGMS NIH HHS/United States; GR: UL1 TR001439/TR/NCATS NIH HHS/United States; GR: R01 GM087285/GM/NIGMS NIH HHS/United States; GR: UL1 RR029876/RR/NCRR NIH HHS/United States; JID: 0372354; NIHMS784886; PMCR: 2017/12/01; ppublish