500 Intracranial Injuries and the Effect of Fluid Resuscitation in Burn Patients

Abstract Introduction Few studies exist that describe the neurologic injuries seen in patients admitted to the burn ICU. Patients who have sustained a severe thermal injury undergo complex metabolic, hemodynamic, and inflammatory changes and require aggressive fluid resuscitation. The neurologic consequences of burn-associated resuscitation may have clinical implications. The purpose of this study was to evaluate the intracranial neurologic injuries and how they relate to volume of burn-related resuscitation fluids administered. Methods We performed a retrospective analysis of all patients admitted to the Burn ICU at a single facility between January 2003 and June 2017. Patients were included if they were admitted within 24 hours of their burn injury and obtained head computed tomography (CT) for any indication in the first 96 hours of hospitalization. Results Of a total 5176 patients admitted, 439 met the inclusion criteria. An acute intracranial process was identified in 41 cases. 27 patients received 0–150 cc/kg of IV fluids, while 11 received >200 cc/kg during the first 24 hours. The most common injuries in the former were hemorrhage (subarachnoid, intraparenchymal) and edema (7/27 for each), while ischemia/infarction (4/11) was the most frequent in those receiving >200 cc/kg. Follow up imaging was more likely to be worse in the >200 cc/kg group (5/11) than in the < 150 cc/kg group (2/27). Conclusions Of patients admitted to the Burn ICU within 24 hours of injury and who received a head CT within the first 96 hours, an acute intracranial abnormality was found in 8% of patients. The most common diagnosis was hemorrhage in those receiving < 150 cc/kg of IV resuscitation, while ischemic/infarction was more common in those receiving >200 cc/kg. Follow up imaging in those receiving more IV fluids was more likely to demonstrate worsening, which could suggest that increased resuscitation leads to worsening intracerebral outcomes. Applicability of Research to Practice Having a high index of suspicion for intracranial complications related to resuscitation improves the multi-disciplinary team’s ability to prevent, identify early and treat appropriately in order to improve patient outcomes.