402 Enteral Resuscitation Shows Similar Efficacy to IV Resuscitation in a Porcine 40%TBSA Contact Model

Abstract Introduction Adequate intravenous (IV) resuscitation of burn patients has improved outcomes and become a cornerstone of modern burn care. However, the volumes/types of fluids that address the delicate balance between over- and under-resuscitation remain controversial. Simultaneously, limited evidence touts the potential efficacy of enteral resuscitation which may reduce IV fluid requirements and buy precious time in mass casualty and prolonged field care scenarios. The current study examines the efficacy of enteral resuscitation with the World Health Organizations Oral Rehydration Solution (ORS) in a 40% total body surface area (TBSA) contact burn in swine. Methods Anesthetized Yorkshire pigs (n=6/group) sustained 40% TBSA full-thickness contact burns with brass probes heated to 100ºC and were randomized to one of 4 resuscitation strategies: high-volume (70 mL/kg/d) enteral ORS only (HV-ORS); low-volume (15 mL/kg/d) enteral ORS only (LV-ORS); LV-ORS + IV lactated Ringer’s at 15 mL/kg/d (LV-IV); or LV-ORS + IV lactated Ringer’s via the modified Brooke formula (HV-IV). Urine and blood samples were collected at baseline (BL), 6, 12, 24, 32, and 48 hours post-burn. Results Animals in the HV-IV group gained significantly more weight (2.5 ± 0.4 kg) in 48 h than the other groups, which lost 0.3 ± 0.5, 2.5 ± 0.3, and 0.1 ± 0.7kg in the HV-ORS, LV-ORS, and LV-IV groups, respectively. HV-IV animals also became slightly anemic at 48 h, with 5.7 ± 0.2, 6.1 ± 0.2, 5.2 ± 0.1 and 6.0 ± 0.3 x106 RBCs/µL in HV-ORS, LV-ORS, HV-IV and LV-IV, respectively. Urine output was higher in HV-ORS and HV-IV than LV-ORS and LV-IV groups (1.05 ± 0.2, 0.85 ± 0.12, 0.55 ± 0.07, and 0.57 ± 0.05 ml/kg/h, respectively). Plasma creatinine peaked at hour 6 in all animals, but returned to baseline levels by hour 48 in all groups except LV-ORS, while BUN also rose and was highest in LV-ORS and LV-IV groups at 48 hours. Urinary protein gradually rose, with 48 h values of 137.1 ± 25.0, 219.9 ± 29.5, 197.2 ± 56.6, and 221.0 ± 49.2 mg/dl in the HV-ORS, LV-ORS, HV-IV and LV-IV groups, respectively. Conclusions Taken together, the data suggest that enteral resuscitation after burn injury provides therapeutic benefit for ameliorating acute kidney injury. Further studies into the types and volumes of enteral fluids, and what patients they may be efficacious in are warranted. Applicability of Research to Practice Incorporating enteral fluids may reduce IV fluid volumes and prevent co-morbiditie