Understanding the role of serum lactate as an end point in burn resuscitation

Abstract

Context: Fluid resuscitation plays a significant role in burns treatment. Inappropriate resuscitation impacts morbidity and mortality. Urine output (UO), the current gold standard, alone, is not an adequate end point of fluid resuscitation in burns. Hence, we studied the utility of serum lactate levels as a reliable marker and end point of resuscitation. Aims: (a) To understand the role of serum lactate levels in burns as end point in acute burn resuscitation and (b) To assess its sensitivity and specificity. Settings and Design: Tertiary care hospital, urban setting, and cross-sectional study. Subjects and Methods: The study was done from September 2015 to July 2017. Sixty-four patients with thermal burns were included. Serum lactate levels were recorded at arrival, 8 h, 16 h, 24 h, and 48 h interval postburn incident. Hourly UO heart rate and mean arterial pressure were recorded for the outcome measures. Statistical Analysis Used: Chi-square test and nonparametric Mann–Whitney U-test. P ≤ 0.05 was considered statistically significant. Results: (a) The initial serum lactate levels at presentation were directly proportional to: The total body surface area and percent deep component of burns sustained Delay in starting resuscitation. b. Time taken for serum lactate levels to normalize is directly proportional to initial serum lactate level. At 16 h, serum lactate showed (94%) specificity, (53%) sensitivity, and at 48 h (85%) sensitivity, (44%) specificity. Conclusions: Serum lactate levels can help to monitor the adequacy of fluid resuscitation in burns. Serum lactate and UO, both, should be taken into consideration to determine the end point of resuscitation.