This is a critical care study that showcases an interesting tool developed for ICU resuscitation of severe burns. The authors make the case that adequate resuscitation for burns, i.e., the Parkland Formula, is necessary – but that patients are frequently over-resuscitated. Rather than simply settling for the rigid, formulaic crystalloid infusion over the first 24 hours, they developed a computer feedback loop that altered the infusion rates based on urine output. Think of it as insulin drip protocol or heparin infusion protocol – but instead of glucose or PTT, you’re measuring UOP and adjusting the fluid rate dynamically on an hourly basis.
I like this study because they have a primary outcome – improved adherence to their UOP target – and then secondary outcome variables that matter, mortality, ICU days, ventilator-free days. While secondary outcomes are hypothesis-generating tools, making a rational leap to connect the association between their UOP adherence and the massive improvement in mortality demonstrated would not be reproachable.
It is not a large study – and the control group had the same % BSA burn, but had significantly more % full thickness burns. The magnitude of the mortality outcome could certainly be affected by more demographics than they report, so a follow-up is necessary. However, the premise of a feedback loop offloading cognitive tasks from providers as part of the management of a complex system is almost certainly something we’re going to see more of in medicine.