Comparison of Venous Excess Ultrasound Grading (VEXUS) based fluid management with standard fluid management in critically ill adult burn injury patients post initial resuscitation - a randomized controlled study

Fluid resuscitation in burn injury patients is the first and most vital cog in the ICU management of these patients. Several formulae are in use to calculate the volume of fluid to be given to cover the losses, including Parkland’s formula, and Modified Brooke’s formula . However, most of these formulae were found to overpredict the volume deficit among burn injury patients, thus leading to volume overload.

Fluid creep is a common manifestation of burn injury resuscitation and has been found to present with several unwanted complications in patients(2). These include pulmonary edema, peripheral edema, decreased wound healing, compartment syndrome leading to increased ICU days and poorer outcomes(3). Another dreaded complication of fluid overload is AKI (4)Thus, monitoring adequacy of fluid resuscitation becomes essential.

Current standard methods of monitoring fluid status include urine output, lactate clearance, central venous pressure, pulse volume and blood pressure(5). The disadvantage with these methods is the subjective difference between each patient as well as between clinicians, which makes it harder to arrive at an appropriate target. Newer methods of assessing fluid status such as the Venous excess ultrasound score (VEXUS) have shown to be promising in terms of their accuracy and sensitivity in predicting fluid overload and AKI(6,7).

This randomised controlled study is aimed at comparing the incidence of AKI in critically ill burn injury patients who undergo VExUS based fluid management compared to standard fluid management, post burn resuscitation, at the end of 1 week.