HighRateIV

Description

This scenario provides a qualitative comparison of human burn patients using data from swine experiments.

Paradigm 3: A high rate of >=500 mL/h IV Lactate Ringers throughout the protocol to deliberately over-resuscitate the animals.

Protocol: Female Yorkshire swine were acclimated to the facility for 5 days prior to experimental use. Animals were fasted but allowed water ad libitum 12 hours prior to the study. Animals were monitored for 24 hours postinjury, with their vitals recorded every 15 minutes, and blood samples collected at hours 1, 2, 3, 6, 9, 12, 18, and 24.

Burn Distribution

Figure 1. Lund-Browder chart showing burn distribution and severity.

Segment Validation

Segment 1

Animals were sedated using ketamine 15 to 30 mg/kg and xylazine 1 to 4 mg/kg IM. Animals were endotracheally intubated and ventilated. Ventilator setting were 1 to 3 l/min of oxygen, 7 to 15 ml/kg tidal volume, and 10 to 20 bpm, to maintain end-tidal CO2 of 40 +/- 5 mm Hg General anesthesia was maintained using a combination of propofol (200 mcg/min/kg IV), ketamine (10-30 mg/hr/kg IV), vecuronium (0.15-1 mg/hr/kg IV), and fentanyl (3-4 ug/hr/kg IV) Animals were then subjected to a 40% TBSA burn with an aluminum branding iron heated to 150 degC kept in contact with the skin for 10 seconds producing a full-thickness burn Animals received IV Lactated Ringers solution at a high rate resulting in approximately 15 ml/kg/h. Run for 4 hrs.

Table 1. Data request validation results for Segment 1.

Property Name	Validation	Engine Value	Percent Error	Percent Change	Notes
ThermalBurn-TotalBodySurfaceArea	EqualTo 0.40 [14] [15]	0.400	0.00%		Directly set
RespirationRate(1/min)	[10.0,20.0] [14] [15]	18.0	0.00%		Ventilator protocol
TidalVolume(mL)	[527,1.13e+03] [14] [15]	628	0.00%		Ventilator protocol
EndTidalCarbonDioxidePressure(mmHg)	[35.0,45.0] [14] [15]	28.6	-18.18%		Ventilator protocol
UrineProductionRate(mL/min)	EqualTo Baseline (0.929) [14] [15]	1.59	71.65%		No change
CardiacOutput(L/min)	EqualTo Baseline (5.78) [14] [15]	9.66	67.17%		No change
HeartStrokeVolume(mL)	GreaterThan Baseline (80.2) [14]	288		258.92%	Increase
CentralVenousPressure(mmHg)	LessThan Baseline (4.80) [15]	10.8	125.08%		Decrease
MeanArterialPressure(mmHg)	LessThan Baseline (95.3) [15]	99.6	4.51%		Decrease

Figure 2. Vitals monitor for Segment 1.

Table 2. Data requests for Segment 1.

Property Name	Engine Value
Patient-Weight(kg)	78.8
ECG-Lead3ElectricPotential(mV)	-0.0484
HeartRate(1/min)	33.6
HeartStrokeVolume(mL)	288
HeartEjectionFraction	0.809
BloodVolume(L)	9.53
ExtravascularFluidVolume(L)	33.6
ArterialPressure(mmHg)	141
MeanArterialPressure(mmHg)	99.6
SystolicArterialPressure(mmHg)	165
DiastolicArterialPressure(mmHg)	44.5
CardiacOutput(L/min)	9.66
HemoglobinContent(g)	821
CentralVenousPressure(mmHg)	10.8
PulmonaryCapillariesWedgePressure(mmHg)	17.2
TidalVolume(mL)	628
TotalLungVolume(mL)	2.79e+03
RespirationRate(1/min)	18.0
OxygenSaturation	0.979
CarbonDioxideSaturation	0.0297
EndTidalCarbonDioxideFraction	0.0375
EndTidalCarbonDioxidePressure(mmHg)	28.6
TotalAlveolarVentilation(L/min)	8.55
TranspulmonaryPressure(cmH2O)	19.7
CoreTemperature(degC)	37.0
SkinTemperature(degC)	31.4
RespiratoryExchangeRatio	0.688
OxygenConsumptionRate(mL/min)	347
CarbonDioxideProductionRate(mL/min)	239
GlomerularFiltrationRate(mL/min)	138
RenalBloodFlow(L/min)	2.25
UrineProductionRate(mL/min)	1.59
LeftAfferentArterioleResistance(mmHg_min/mL)	0.0367
RightAfferentArterioleResistance(mmHg_min/mL)	0.0367
SystemicVascularResistance(mmHg_s/mL)	0.550
LeftAlveoli-Pressure(cmH2O)	1.05e+03
RightAlveoli-Pressure(cmH2O)	1.05e+03
Pericardium-Volume(mL)	15.0
Pericardium-Pressure(mmHg)	1.00
Trachea-Oxygen-PartialPressure(mmHg)	162
Trachea-CarbonDioxide-PartialPressure(mmHg)	0.385
LeftLungPulmonary-Oxygen-PartialPressure(mmHg)	127
RightLungPulmonary-Oxygen-PartialPressure(mmHg)	125
LeftLungPulmonary-CarbonDioxide-PartialPressure(mmHg)	26.7
RightLungPulmonary-CarbonDioxide-PartialPressure(mmHg)	27.3
LeftAlveoli-Oxygen-PartialPressure(mmHg)	126
LeftAlveoli-CarbonDioxide-PartialPressure(mmHg)	27.3
RightAlveoli-Oxygen-PartialPressure(mmHg)	124
RightAlveoli-CarbonDioxide-PartialPressure(mmHg)	28.0
Aorta-Oxygen-PartialPressure(mmHg)	88.5
Aorta-CarbonDioxide-PartialPressure(mmHg)	29.6
VenaCava-Oxygen-PartialPressure(mmHg)	32.4
VenaCava-CarbonDioxide-PartialPressure(mmHg)	40.8
RightTubules-Sodium-Concentration(g/L)	4.06
LeftTubules-Sodium-Concentration(g/L)	4.06
Oxygen-AlveolarTransfer(mL/min)	283
CarbonDioxide-AlveolarTransfer(mL/min)	-10.1
Epinephrine-BloodConcentration(ug/L)	0.0363
Epinephrine-SystemicMassCleared(ug)	49.1
Norepinephrine-BloodConcentration(ug/L)	0.188
Norepinephrine-SystemicMassCleared(ug)	170

Segment 2

Run for 4 hrs.

Table 3. Data request validation results for Segment 2.

Property Name	Validation	Engine Value	Percent Error	Percent Change	Notes
UrineProductionRate(mL/min)	GreaterThanEqualTo Segment1 (1.59) [14] [15]	2.02		26.80%	Increase or no change
CardiacOutput(L/min)	GreaterThanEqualTo Segment1 (9.66) [14] [15]	10.7		10.51%	Increase or no change
HeartStrokeVolume(mL)	EqualTo Segment1 (288) [14]	534	85.64%		No change
CentralVenousPressure(mmHg)	GreaterThan Segment1 (10.8) [15]	18.0		66.28%	Increase
MeanArterialPressure(mmHg)	EqualTo Segment1 (99.6) [15]	101	1.21%		No change

Figure 3. Vitals monitor for Segment 2.

Table 4. Data requests for Segment 2.

Property Name	Engine Value
Patient-Weight(kg)	81.5
ECG-Lead3ElectricPotential(mV)	-0.0238
HeartRate(1/min)	20.0
HeartStrokeVolume(mL)	534
HeartEjectionFraction	0.901
BloodVolume(L)	13.3
ExtravascularFluidVolume(L)	33.8
ArterialPressure(mmHg)	82.1
MeanArterialPressure(mmHg)	101
SystolicArterialPressure(mmHg)	218
DiastolicArterialPressure(mmHg)	37.2
CardiacOutput(L/min)	10.7
HemoglobinContent(g)	821
CentralVenousPressure(mmHg)	18.0
PulmonaryCapillariesWedgePressure(mmHg)	29.3
TidalVolume(mL)	628
TotalLungVolume(mL)	2.30e+03
RespirationRate(1/min)	18.0
OxygenSaturation	0.982
CarbonDioxideSaturation	0.0309
EndTidalCarbonDioxideFraction	0.0343
EndTidalCarbonDioxidePressure(mmHg)	26.2
TotalAlveolarVentilation(L/min)	8.55
TranspulmonaryPressure(cmH2O)	9.51
CoreTemperature(degC)	36.7
SkinTemperature(degC)	30.9
RespiratoryExchangeRatio	0.685
OxygenConsumptionRate(mL/min)	341
CarbonDioxideProductionRate(mL/min)	233
GlomerularFiltrationRate(mL/min)	29.7
RenalBloodFlow(L/min)	1.16
UrineProductionRate(mL/min)	2.02
LeftAfferentArterioleResistance(mmHg_min/mL)	0.0367
RightAfferentArterioleResistance(mmHg_min/mL)	0.0367
SystemicVascularResistance(mmHg_s/mL)	0.470
LeftAlveoli-Pressure(cmH2O)	1.04e+03
RightAlveoli-Pressure(cmH2O)	1.04e+03
Pericardium-Volume(mL)	15.0
Pericardium-Pressure(mmHg)	1.00
Trachea-Oxygen-PartialPressure(mmHg)	125
Trachea-CarbonDioxide-PartialPressure(mmHg)	25.9
LeftLungPulmonary-Oxygen-PartialPressure(mmHg)	125
RightLungPulmonary-Oxygen-PartialPressure(mmHg)	123
LeftLungPulmonary-CarbonDioxide-PartialPressure(mmHg)	26.3
RightLungPulmonary-CarbonDioxide-PartialPressure(mmHg)	26.8
LeftAlveoli-Oxygen-PartialPressure(mmHg)	125
LeftAlveoli-CarbonDioxide-PartialPressure(mmHg)	26.3
RightAlveoli-Oxygen-PartialPressure(mmHg)	123
RightAlveoli-CarbonDioxide-PartialPressure(mmHg)	26.8
Aorta-Oxygen-PartialPressure(mmHg)	89.2
Aorta-CarbonDioxide-PartialPressure(mmHg)	27.2
VenaCava-Oxygen-PartialPressure(mmHg)	28.3
VenaCava-CarbonDioxide-PartialPressure(mmHg)	35.7
RightTubules-Sodium-Concentration(g/L)	4.17
LeftTubules-Sodium-Concentration(g/L)	4.17
Oxygen-AlveolarTransfer(mL/min)	356
CarbonDioxide-AlveolarTransfer(mL/min)	-226
Epinephrine-BloodConcentration(ug/L)	0.0362
Epinephrine-SystemicMassCleared(ug)	96.0
Norepinephrine-BloodConcentration(ug/L)	0.180
Norepinephrine-SystemicMassCleared(ug)	331

Segment 3

Run for 4 hrs.

Table 5. Data request validation results for Segment 3.

Property Name	Validation	Engine Value	Percent Error	Percent Change	Notes
UrineProductionRate(mL/min)	GreaterThan Segment2 (2.02) [14] [15]	2.37		17.05%	Increase
CardiacOutput(L/min)	GreaterThan Segment2 (10.7) [14] [15]	10.9		2.06%	Increase
HeartStrokeVolume(mL)	GreaterThanEqualTo Segment2 (534) [14]	772		44.39%	Increase or no change
CentralVenousPressure(mmHg)	GreaterThan Segment2 (18.0) [15]	22.8		27.08%	Increase
MeanArterialPressure(mmHg)	EqualTo Segment2 (101) [15]	102	0.96%		No change

Figure 4. Vitals monitor for Segment 3.

Table 6. Data requests for Segment 3.

Property Name	Engine Value
Patient-Weight(kg)	83.1
ECG-Lead3ElectricPotential(mV)	0.126
HeartRate(1/min)	14.1
HeartStrokeVolume(mL)	772
HeartEjectionFraction	0.941
BloodVolume(L)	16.9
ExtravascularFluidVolume(L)	34.2
ArterialPressure(mmHg)	45.2
MeanArterialPressure(mmHg)	102
SystolicArterialPressure(mmHg)	262
DiastolicArterialPressure(mmHg)	39.9
CardiacOutput(L/min)	10.9
HemoglobinContent(g)	822
CentralVenousPressure(mmHg)	22.8
PulmonaryCapillariesWedgePressure(mmHg)	41.1
TidalVolume(mL)	628
TotalLungVolume(mL)	2.35e+03
RespirationRate(1/min)	18.0
OxygenSaturation	0.982
CarbonDioxideSaturation	0.0315
EndTidalCarbonDioxideFraction	0.0329
EndTidalCarbonDioxidePressure(mmHg)	25.1
TotalAlveolarVentilation(L/min)	8.55
TranspulmonaryPressure(cmH2O)	22.1
CoreTemperature(degC)	36.7
SkinTemperature(degC)	30.8
RespiratoryExchangeRatio	0.641
OxygenConsumptionRate(mL/min)	276
CarbonDioxideProductionRate(mL/min)	177
GlomerularFiltrationRate(mL/min)	-34.6
RenalBloodFlow(L/min)	0.409
UrineProductionRate(mL/min)	2.37
LeftAfferentArterioleResistance(mmHg_min/mL)	0.0367
RightAfferentArterioleResistance(mmHg_min/mL)	0.0367
SystemicVascularResistance(mmHg_s/mL)	0.432
LeftAlveoli-Pressure(cmH2O)	1.04e+03
RightAlveoli-Pressure(cmH2O)	1.04e+03
Pericardium-Volume(mL)	15.0
Pericardium-Pressure(mmHg)	1.00
Trachea-Oxygen-PartialPressure(mmHg)	140
Trachea-CarbonDioxide-PartialPressure(mmHg)	15.6
LeftLungPulmonary-Oxygen-PartialPressure(mmHg)	126
RightLungPulmonary-Oxygen-PartialPressure(mmHg)	124
LeftLungPulmonary-CarbonDioxide-PartialPressure(mmHg)	25.9
RightLungPulmonary-CarbonDioxide-PartialPressure(mmHg)	26.3
LeftAlveoli-Oxygen-PartialPressure(mmHg)	126
LeftAlveoli-CarbonDioxide-PartialPressure(mmHg)	26.1
RightAlveoli-Oxygen-PartialPressure(mmHg)	124
RightAlveoli-CarbonDioxide-PartialPressure(mmHg)	26.5
Aorta-Oxygen-PartialPressure(mmHg)	88.4
Aorta-CarbonDioxide-PartialPressure(mmHg)	25.8
VenaCava-Oxygen-PartialPressure(mmHg)	25.5
VenaCava-CarbonDioxide-PartialPressure(mmHg)	33.4
RightTubules-Sodium-Concentration(g/L)	5.19
LeftTubules-Sodium-Concentration(g/L)	5.19
Oxygen-AlveolarTransfer(mL/min)	201
CarbonDioxide-AlveolarTransfer(mL/min)	-93.1
Epinephrine-BloodConcentration(ug/L)	0.0361
Epinephrine-SystemicMassCleared(ug)	144
Norepinephrine-BloodConcentration(ug/L)	0.177
Norepinephrine-SystemicMassCleared(ug)	496

Scenario Output Plots

Figure 5. Select outputs from the scenario.