Acute kidney injury in critically burned patients resuscitated with a protocol that includes low doses of Hydroxyethyl Starch.
Acute kidney injury (AKI) is an important complication in burn patients. Recently, it has been recommended that hydroxyethyl starch (HES) be avoided in burn patients because it increases the incidence of AKI. Our purpose was to study incidence of AKI in critically ill burn patients resuscitated with Ringer's solution and supplements of HES. We conducted an observational study of 165 patients admitted to the critical care burn unit (with 30 ± 15% TBSA burned). The main outcome measures were incidence of AKI, contributions of colloids and crystalloids, various severity scores, comorbidities, complications and mortality. According to the RIFLE criteria, 10 (6.1%) patients presented with Risk, 11 (6.7%) presented with Injury and 11 (6.7%) presented with Failure. According to the AKIN criteria, 9.7% presented stage I, 3% stage II and 10.3% stage III. Replacement therapy (RRT) was performed in 15 patients (9.1%), but in 6 of them RRT was employed in the final stages of multi-organ failure. The incidence of AKI in severe burn patients is high according to the RIFLE or AKIN criteria and these patients experience more complications and higher mortality. Our study suggests that the use of HES in low doses in the burn resuscitation phase does not cause more AKI than resuscitation without HES, but further evaluation is required. Further studies should be conducted.
Department of Intensive Care Medicine, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain.
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M
Sánchez-Sánchez
Department of Intensive Care Medicine, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain.
A
A
Garcia-de-Lorenzo
Department of Intensive Care Medicine, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain.
L
L
Cachafeiro
Department of Intensive Care Medicine, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain.
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E
Herrero
Department of Intensive Care Medicine, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain.
M J
MJ
Asensio
Department of Intensive Care Medicine, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain.
A
A
Agrifoglio
Department of Intensive Care Medicine, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain.
E
E
Flores
Department of Intensive Care Medicine, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain.
B
B
Estebanez
Department of Intensive Care Medicine, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain.
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P
Extremera
Department of Plastic Surgery, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain.
C
C
Iglesias
Department of Plastic Surgery, University Hospital La Paz-Carlos III/IdiPAZ, Madrid, Spain.
J R
JR
Martinez
burns; renal; resuscitation