Net fluid accumulation and outcome. A randomized clinical trial.

Outcome measures are the first step in determining the consequences of health care. These include mortality, morbidity, and quality of life. As major burns are life-threatening conditions, the main priority in discussing outcome measures is mortality as a problem-specific measure. A number of studies have shown that mortality is predominantly determined by many variables obtained as "admission" predictors" as also by numerous variables obtained during the hospital course. Net fluid accumulation (NFA) is one of the many important factors that correlate with clinical outcome. The purpose of this paper is thus to evaluate NFA during resuscitation with Ringer's lactate (RL) and its relationship with mortality. We hypothesized that rigorous monitoring of fluid replacement therapy might result in lower fluid retention, which could be effective in the prognosis of severely burned patients. In this prospective randomized study, the patients were divided into two groups of 55 cases each. In RL group 1, the patients were resuscitated using the Parkland formula in adults and the Galveston Shriner formula in children, without modifications, while in RL group 2 the formula was utilized as a starting-point only and the amount of fluid was modified in each case on the basis of the clinical situation and urine output. It was found that there was a statistically significant difference in NFA between the two groups (p = 0.001), as also a statistically significant difference between the amount of fluids given and the complications (p = 0.08). The majority of patients who died (70%) presented higher NFA values in the period of resuscitation. There was a statistically significant difference between mortality and total body surface area burned (p = 0.036), comorbidities (p = 0.015), cause of burn (p = 0.004), inhalation injury (p = 0.027). The degree of NFA correlated, with a linear positive relationship, with morbidity (Kendall's tau_br = 0.143, p = 0.019) and, with a negative relationship, with mortality (Kendall's tau_br = 0.234, p = 0.001). Mortality as the primary endpoint was 16% in group 1 and 9% in group 2. Giving the smallest amount of fluids necessary for adequate resuscitation can be effective in creating a successful and specific therapy for all burn patients. With regard to morbidity and mortality, predictor factors, as also the method of resuscitation, have an influence in maintaining constant NFA values.