title: Serum lactate and base deficit suggest inadequate resuscitation of patients with burn injuries: application of a point-of-care laboratory instrument.
abstract: Urinary output of 30 to 50 ml/hr and mean arterial pressure of more than 70 mm Hg continue to be the yardsticks by which patients with burn injuries are resuscitated. We designed this prospective, descriptive study to compare these parameters with serial base deficit and serum lactate values, which have been found to be sensitive indicators of adequate fluid resuscitation in trauma patients. The sample group consisted of 53 patients, consecutively admitted to the burn intensive care unit, who had 15% or more total body surface area burns. No changes in resuscitation protocol were implemented. Within the 48-hour period after admission, 2 ml heparinized venous blood samples were collected and analyzed every 2 to 4 hours, and vital signs, urinary output, fluid type, and volume administered were documented each hour. Urinary output and mean arterial pressure were maintained at more than 30 ml/hr and more than 70 mm Hg, respectively. Partial correlations between the traditional resuscitation variables and serum lactate and base deficit were low. On average, serum lactate and base deficit remained abnormally high during the study period. These new parameters may be used to improve the fidelity with which burn shock resuscitation is undertaken. Further studies of these parameters and how they may be used as endpoints in fluid resuscitation are needed.
authors.affiliation: Burn Center at Washington Hospital Center, Washington DC 20010, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Jeng
authors.forename: K
authors.initials: K
authors.lastname: Lee
authors.forename: K
authors.initials: K
authors.lastname: Jablonski
authors.forename: M H
authors.initials: MH
authors.lastname: Jordan
mesh_terms: D000138:Acidosis; D000328:Adult; D015415:Biomarkers; D002056:Burns / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy; D017408:Guidelines as Topic; D006801:Humans; D015601:Injury Severity Score; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D011446:Prospective Studies; D014556:Urine
chemical_list: D015415:Biomarkers; D019344:Lactic Acid