(1571) Effect of Dexmedetomidine on Fluid Resuscitation in Burn-Injured Patients

Introduction: Fluid resuscitation requirements for patients with extensive burn injury can be estimated by the Parkland Formula, but may reach volumes higher than predicted – a phenomenon termed “fluid creep”. Since this has been described in patients with high opioid requirements, continuous analgesics and sedatives, including dexmedetomidine, have been avoided during resuscitation. Currently, there are no studies evaluating the effect of dexmedetomidine on fluid requirements. The purpose of this study was to describe the impact of dexmedetomidine continuous infusion on fluid resuscitation requirements in the first 48 hours following burn injury.

Methods: This retrospective cohort study included adult patients with burns greater than 20% total body surface area (TBSA) resuscitated between January 2017 and June 2022 at our regional burn center. Patients who died within 48 hours of burn were excluded. Patients who received dexmedetomidine for at least 6 hours were included in the dexmedetomidine group. The primary outcome was volume of fluid required in the first 24 and 48 hours post-burn. Secondary outcomes were the incidence of acute respiratory distress syndrome (ARDS), delayed escharotomy/fasciotomy, intraabdominal hypertension, or renal replacement therapy (RRT) within 7 days post-burn. Weighted Student’s t-test, Chi-squared, and Fisher’s Exact tests were used for analysis.

Results: A total of 170 patients were included for analysis: 55 patients in the intervention group and 115 patients in the control group. After propensity matching for variables associated with fluid creep, the dexmedetomidine cohort required 4.2 ± 1.7 mL/kg/%TBSA in the first 24h of resuscitation compared to 3.6 ± 1.1 mL/kg/%TBSA in the control cohort (p=0.03). The difference was no longer significant at 48 hours post-burn (p=0.11). There were no significant differences in the incidence of ARDS, delayed escharotomy/fasciotomy, intraabdominal hypertension, or RRT.

Conclusions: Dexmedetomidine exposure in the acute resuscitation period resulted in increased fluid requirements in the first 24 hours, suggesting it is independently associated with fluid creep; however, this increase was not sustained at 48 hours. The clinical significance of this finding is unclear as there was no increase in adverse events between cohorts in this study.