Serum lactate, not base deficit, rapidly predicts survival after major burns
Introduction
The Parkland formula is a quarter-century old [1]. As reliable as it has been, it was derived during a different era of medical science and practice. Others and we now wonder if particular serum resuscitation markers could be used to augment standard urine output monitoring in difficult burn resuscitations, as barometers of injury severity/host response, or as prognostic tools [2], [3], [4], [5], [6], [7], [8], [9].
We have previously reported abnormally high serum lactate and base deficit levels during resuscitation to urine output alone [2]. Their presence suggests that acutely abnormal cellular physiology may remain unaddressed with current practices [10], [11], [12]. Correcting fundamental cellular physiology might be an elegant strategy to improve outcomes after major burns. Demonstrating the unfavorable prognostic value of abnormal serum lactate and base deficit would be a logical first step.
In this study, we therefore sought to determine whether serum lactate and/or base deficit could be used as a prognostic tool in burn injury.
Section snippets
Clinical protocol
Sixty-nine consecutive patients who were admitted to the adult Burn ICU with greater than 15% total body surface area (TBSA) burned were enrolled in this study.
The study was approved by the MedStar Research Institute’s Research Committee and Institutional Review Board (IRB). The IRB approved a waiver of the requirement for informed consent as permitted by federal regulations, given the emergent setting and micro-sampling techniques used.
Initiation of the study protocol was begun as proximal to
Results
Of the 69 patients enrolled in the study, 49 were incorporated into the statistical analysis (Table 1). Twenty patients were not included in the final data analysis due to data dropout from machine unavailability. There were no statistical differences between the 20 excluded patients and the study patients in age, TBSA, second or third degree burn (P>0.15, median test).
The median time from injury to admission was 1 h. Most patients arrived to the burn center immediately after injury, as
Discussion
End points for resuscitation remains a controversial topic with all forms of shock [16], [17], [18]. Although not unanimously accepted, abnormal serum lactate and base deficit are felt by many to be precise markers of cellular and whole organism shock [13], [14], [16], [17], [19], [20]. The correlation between lactate and base deficit with clinical outcome has been well described in hemorrhagic and septic shock [14], [15], [16], [17], [19], [20]. Both serum lactate and base deficit have been
Conclusion
Our results indicate that serum lactate levels plainly predict survival or mortality after major burns. Serum lactate and base deficit are not equal in the consideration of burn shock. Titration of burn resuscitation to normalize lactate may be a plausible method to reduce burn mortality in an experimental model. If successful, a clinical trial would be warranted.
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