title: Computerized decision support system improves fluid resuscitation following severe burns: an original study.
abstract: OBJECTIVE
  Several formulas have been developed to guide resuscitation in severely burned patients during the initial 48 hrs after injury. These approaches require manual titration of fluid that may result in human error during this process and lead to suboptimal outcomes. The goal of this study was to analyze the efficacy of a computerized open-loop decision support system for burn resuscitation compared to historical controls.
  
  
  METHODS
  Fluid infusion rates and urinary output from 39 severely burned patients with >20% total body surface area burns were recorded upon admission (Model group). A fluid-response model based on these data was developed and incorporated into a computerized open-loop algorithm and computer decision support system. The computer decision support system was used to resuscitate 32 subsequent patients with severe burns (computer decision support system group) and compared with the Model group.
  
  
  METHODS
  Burn intensive care unit of a metropolitan Level 1 Trauma center.
  
  
  METHODS
  Acute burn patients with >20% total body surface area requiring active fluid resuscitation during the initial 24 to 48 hours after burn.
  
  
  RESULTS
  We found no significant difference between the Model and computer decision support system groups in age, total body surface area, or injury mechanism. Total crystalloid volume during the first 48 hrs post burn, total crystalloid intensive care unit volume, and initial 24-hr crystalloid intensive care unit volume were all lower in the computer decision support system group. Infused volume per kilogram body weight (mL/kg) and per percentage burn (mL/kg/total body surface area) were also lower for the computer decision support system group. The number of patients who met hourly urinary output goals was higher in the computer decision support system group.
  
  
  CONCLUSIONS
  Implementation of a computer decision support system for burn resuscitation in the intensive care unit resulted in improved fluid management of severely burned patients. All measures of crystalloid fluid volume were reduced while patients were maintained within urinary output targets a higher percentage of the time. The addition of computer decision support system technology improved patient care.
authors.affiliation: U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA. jose.salinas4@us.army.mil
authors.forename: José
authors.initials: J
authors.lastname: Salinas
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Chung
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Mann
authors.forename: Leopoldo C
authors.initials: LC
authors.lastname: Cancio
authors.forename: George C
authors.initials: GC
authors.lastname: Kramer
authors.forename: Maria L
authors.initials: ML
authors.lastname: Serio-Melvin
authors.forename: Evan M
authors.initials: EM
authors.lastname: Renz
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.forename: Steven E
authors.initials: SE
authors.lastname: Wolf
mesh_terms: D000328:Adult; D000465:Algorithms; D002056:Burns / Q000628:therapy*; D003658:Decision Making, Computer-Assisted; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015532:Rehydration Solutions / Q000008:administration & dosage / Q000627:therapeutic use; D012151:Resuscitation / Q000379:methods
chemical_list: D015532:Rehydration Solutions