Background, Rationale, and Purpose of Study: Burn injuries are common during military engagements and may occur more often in future conflicts. Severe burns may be associated with a phenomenon known as burn shock. Burn shock is characterized by massive intravenous fluid loss resulting in impaired organ function, which may be life-threatening. The treatment for burn shock involves precise replacement of intravascular fluid most commonly with an intravenous fluid solution of electrolytes and water. If not enough intravenous fluid is given organ injury may occur. Provision of too much intravenous fluid may too result in organ dysfunction and both life- and limb-threatening complications. Concomitant traumatic injuries may also complicate the resuscitation of burn-injured patients as these injuries may require transfusion of blood products and emergent surgical treatment. Current practice for the resuscitation of burn-injured patients involves monitoring several different parameters, including hourly urine output, blood pressure, and certain blood laboratory values such as lactate and base deficit. These parameters may be difficult to assess in a field care setting, particularly by those with limited healthcare training. This proposal will evaluate a novel technology, compensatory reserve measurement (CRM), in patients with severe burn injuries with or without concomitant traumatic injuries.

Compensatory reserve measurement is based on the principle that the body is able to regulate and overcome intravenous fluid loss by changing blood vessel tone, heart rate, and the contractility function of the heart. CRM offers an ability to monitor how the body's response mechanisms function to prevent the development of shock by measuring the arterial blood pressure waveform. When the continuous waveform tracings are processed through a learning neural network or an artificial intelligence, the machine is able to predict the onset of shock. The ability to understand when the body's mechanisms are starting to fail will indicate to healthcare providers the need to increase the fluid resuscitation. The aim of this study is to compare the CRM trends against the traditional markers of burn resuscitation.

Impact of Research: CRM has been well-studied in traumatic injuries and has been shown to predict shock caused by blood loss. CRM has not been studied in burn resuscitation. This study would provide an evidence base for the ongoing use of CRM for shock states other than those caused by hemorrhage as well as provide a foundation for ongoing studies aimed at assessing the use of CRM to guide resuscitation. This study will measure compensatory reserve utilizing arterial waveform analysis. Once validated, future studies would focus on CRM utilizing non-invasive, point-of care devices that can be applied in the field by medics and non-medical personnel.