title: The association between fluid administration and outcome following major burn: a multicenter study.
abstract: OBJECTIVE
  To determine patient and injury variables that influence fluid requirements following burn injury and examine the association between fluid volume received and outcome.
  
  
  BACKGROUND
  Fluid resuscitation remains the cornerstone of acute burn management. Recent studies suggest that patients today are receiving more fluid per percent total body surface area (TBSA) than in the past. Therefore, there is a need to better define the factors that impact fluid requirements and to determine the effects of fluid volumes on outcome.
  
  
  METHODS
  This study was part of a federally funded multicenter study. Multilinear regression analyses were performed to determine the patient and injury characteristics that most influenced fluid resuscitation volumes received. To assess the association of fluid volumes on outcome, propensity scores were developed to provide a predicted volume of fluid for each patient. Logistic models were then used to assess the impact of excess fluid beyond predicted volumes on outcome.
  
  
  RESULTS
  Seventy-two patients were included in this analysis. Average patient age was 40.6 years and average TBSA was 44.5%. Average fluid volume received during the first 24 hours after injury was 5.2/mL/kg/TBSA. Significant predictors of fluid received included % TBSA, age, intubation status, and weight. Increased fluid volume received increased risk of development of pneumonia (odds ratio [OR] = 1.92), bloodstream infections (OR =2.33), adult respiratory distress syndrome (OR = 1.55), multiorgan failure (OR= 1.49), and death (OR = 1.74).
  
  
  CONCLUSIONS
  TBSA, age, weight, and intubation status on admission were significant predictors of fluid received. Patients who received larger volumes of resuscitation fluid were at higher risk for injury complications and death.
authors.affiliation: University of Washington Burn Center, Harborview, Medical Center, University of Washington, Seattle, WA 98121, USA. mbklein@u.washington.edu
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Klein
authors.forename: Douglas
authors.initials: D
authors.lastname: Hayden
authors.forename: Constance
authors.initials: C
authors.lastname: Elson
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
authors.forename: Richard L
authors.initials: RL
authors.lastname: Gamelli
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Gibran
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
authors.forename: Brett
authors.initials: B
authors.lastname: Arnoldo
authors.forename: Geoff
authors.initials: G
authors.lastname: Silver
authors.forename: David
authors.initials: D
authors.lastname: Schoenfeld
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Tompkins
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000097:blood / Q000150:complications / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome