703 Vasopressors in Early Resuscitation of Severe Burn Injuries
Authors: Knappskog Kristine , Song Juquan , ayadi Amina E I , Golovko Georgiy , Kleinhapl Julia , Guttormsen Anne Berit , Almeland Stian K , Wolf Steven E 
Published: April 2024

Abstract

Introduction
Fluid resuscitation is the main treatment for preventing burn shock. Rescue therapies are usually initiated if patients respond poorly to fluid resuscitation with crystalloids alone. Vasopressors, often in combination with colloids, have been used to limit fluid needs. However, the effects of vasopressors during burn resuscitation remain inadequately investigated.
This study aims to identify the characteristics of patients receiving vasopressors during burn resuscitation and to establish potential correlations between vasopressor use and patient outcomes.

Methods
A large patient database was searched for patients over ≥18 years of age with ≥20% total body surface area (% TBSA) burns. Two cohorts (VP+ and VP-) were established to assess the impact of vasopressors during the initial 24 hours after injury. The cohorts were then stratified by %TBSA. Propensity score matching was performed based on age, gender, ethnicity, race, and comorbidities. Statistical analysis was performed using two sample Z-test, risk ratio (RR) and odds ratio (OR), with p &lt; 0.05 considered significant.

Results
Following propensity matching, the VP+ cohort had a notably higher prevalence of burns exceeding 50% TBSA compared to the VP- cohort (45.9% vs. 27.8%, p &lt; 0.05). Moreover, VP+ patients had a significantly increased incidence of inhalation injuries (67.9% vs. 38.5%, p &lt; 0.05) and were more than twice as likely to require mechanical ventilation within the first day after burn injury (81.0% vs. 31.5%, p &lt; 0.05). During the same period, 28.2% of VP+ patients and 13.0% of VP- patients underwent burn surgery (p &lt; 0.05).
To account for burn severity differences, the cohorts were stratified by %TBSA into subgroups: 20-49% and ≥50%. Both VP+ subgroups had an increased risk of early acute kidney injury (AKI) and increased susceptibility to sepsis, greater need for renal replacement therapy (RRT), and elevated mortality rates by day 30 after burn injury (Table 1). Comparing the VP+ to the VP- cohort, the ORs and RRs for mortality were 4.17 (95% CI 2.57, 6.79) and 3.12 (95% CI 2.08, 4.67) in the 20-49% TBSA subgroup and 2.55 (95% CI 1.69, 3.86) and 1.65 (95% CI 1.32, 2.06) in the ≥50% TBSA subgroup. Similarly, for AKI development, an OR of 3.78 (95% CI 2.50, 5.73) and RR of 2.54 (95% CI 1.87, 3.44) was found in the 20-49% TBSA subgroup, and 3.71 (95% CI 2.42, 5.67) and 2.07 (95% CI 1.62, 2.66) in the ≥50% TBSA subgroup when comparing VP+ to VP-.

Conclusions
After accounting for comorbidities, burn injury patients receiving vasopressors during fluid resuscitation had more severe injuries and faced increased risks of adverse outcomes, including AKI, sepsis, and mortality.

Applicability of Research to Practice
This study raises the question of whether the adverse outcomes observed in burn patients receiving vasopressors are caused by the drugs themselves or merely reflect more severely ill patients. Understanding this distinction could help refine treatment strategies and ensure better outcomes for burn patients.