LowRateIV

Description

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

Paradigm 2: IV Lactated Ringers (LR) guided by urinary output according to maintain a target urine output of 1-1.5 mL/kg.

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 Ringer’s solution at a rate guided by urinary output resulting in approximately 10 ml/kg/h. Run for 4 hrs.

Table 1. Data request validation results for Segment 1.

Property Name	Validation	Engine Value	Percent Error	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]	29.2	-16.49%	Ventilator protocol
UrineProductionRate(mL/min)	LessThan Baseline (0.929) [14] [15]	1.23	32.14%	Decrease
CardiacOutput(L/min)	LessThan Baseline (5.78) [14] [15]	8.79	52.17%	Decrease
HeartStrokeVolume(mL)	LessThan Baseline (80.2) [14]	202	152.14%	Decrease
CentralVenousPressure(mmHg)	LessThan Baseline (4.80) [15]	8.47	76.58%	Decrease
MeanArterialPressure(mmHg)	LessThan Baseline (95.3) [15]	98.7	3.62%	Decrease

Figure 2. Vitals monitor for Segment 1.

Table 2. Data requests for Segment 1.

Property Name	Engine Value
Patient-Weight(kg)	77.9
ECG-Lead3ElectricPotential(mV)	-0.0387
HeartRate(1/min)	43.5
HeartStrokeVolume(mL)	202
HeartEjectionFraction	0.749
BloodVolume(L)	8.09
ExtravascularFluidVolume(L)	33.6
ArterialPressure(mmHg)	55.8
MeanArterialPressure(mmHg)	98.7
SystolicArterialPressure(mmHg)	144
DiastolicArterialPressure(mmHg)	53.6
CardiacOutput(L/min)	8.79
HemoglobinContent(g)	821
CentralVenousPressure(mmHg)	8.47
PulmonaryCapillariesWedgePressure(mmHg)	12.9
TidalVolume(mL)	628
TotalLungVolume(mL)	2.79e+03
RespirationRate(1/min)	18.0
OxygenSaturation	0.978
CarbonDioxideSaturation	0.0293
EndTidalCarbonDioxideFraction	0.0382
EndTidalCarbonDioxidePressure(mmHg)	29.2
TotalAlveolarVentilation(L/min)	8.55
TranspulmonaryPressure(cmH2O)	19.7
CoreTemperature(degC)	37.1
SkinTemperature(degC)	31.1
RespiratoryExchangeRatio	0.688
OxygenConsumptionRate(mL/min)	346
CarbonDioxideProductionRate(mL/min)	238
GlomerularFiltrationRate(mL/min)	10.8
RenalBloodFlow(L/min)	0.697
UrineProductionRate(mL/min)	1.23
LeftAfferentArterioleResistance(mmHg_min/mL)	0.0424
RightAfferentArterioleResistance(mmHg_min/mL)	0.0424
SystemicVascularResistance(mmHg_s/mL)	0.614
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)	126
RightLungPulmonary-Oxygen-PartialPressure(mmHg)	124
LeftLungPulmonary-CarbonDioxide-PartialPressure(mmHg)	27.5
RightLungPulmonary-CarbonDioxide-PartialPressure(mmHg)	28.2
LeftAlveoli-Oxygen-PartialPressure(mmHg)	125
LeftAlveoli-CarbonDioxide-PartialPressure(mmHg)	28.1
RightAlveoli-Oxygen-PartialPressure(mmHg)	123
RightAlveoli-CarbonDioxide-PartialPressure(mmHg)	28.8
Aorta-Oxygen-PartialPressure(mmHg)	87.6
Aorta-CarbonDioxide-PartialPressure(mmHg)	30.3
VenaCava-Oxygen-PartialPressure(mmHg)	33.8
VenaCava-CarbonDioxide-PartialPressure(mmHg)	42.7
RightTubules-Sodium-Concentration(g/L)	4.51
LeftTubules-Sodium-Concentration(g/L)	4.51
Oxygen-AlveolarTransfer(mL/min)	256
CarbonDioxide-AlveolarTransfer(mL/min)	-200
Epinephrine-BloodConcentration(ug/L)	0.0365
Epinephrine-SystemicMassCleared(ug)	48.9
Norepinephrine-BloodConcentration(ug/L)	0.195
Norepinephrine-SystemicMassCleared(ug)	169

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)	EqualTo Segment1 (1.23) [14] [15]	1.65	34.10%		No change
CardiacOutput(L/min)	GreaterThan Segment1 (8.79) [14] [15]	10.1		14.65%	Increase
HeartStrokeVolume(mL)	GreaterThan Segment1 (202) [14]	348		72.20%	Increase
CentralVenousPressure(mmHg)	GreaterThan Segment1 (8.47) [15]	12.8		51.64%	Increase
MeanArterialPressure(mmHg)	EqualTo Segment1 (98.7) [15]	99.8	1.14%		No change

Figure 3. Vitals monitor for Segment 2.

Table 4. Data requests for Segment 2.

Property Name	Engine Value
Patient-Weight(kg)	79.7
ECG-Lead3ElectricPotential(mV)	0.0224
HeartRate(1/min)	28.9
HeartStrokeVolume(mL)	348
HeartEjectionFraction	0.839
BloodVolume(L)	10.5
ExtravascularFluidVolume(L)	33.7
ArterialPressure(mmHg)	83.4
MeanArterialPressure(mmHg)	99.8
SystolicArterialPressure(mmHg)	178
DiastolicArterialPressure(mmHg)	40.5
CardiacOutput(L/min)	10.1
HemoglobinContent(g)	821
CentralVenousPressure(mmHg)	12.8
PulmonaryCapillariesWedgePressure(mmHg)	20.2
TidalVolume(mL)	628
TotalLungVolume(mL)	2.30e+03
RespirationRate(1/min)	18.0
OxygenSaturation	0.980
CarbonDioxideSaturation	0.0300
EndTidalCarbonDioxideFraction	0.0366
EndTidalCarbonDioxidePressure(mmHg)	28.0
TotalAlveolarVentilation(L/min)	8.55
TranspulmonaryPressure(cmH2O)	9.51
CoreTemperature(degC)	36.8
SkinTemperature(degC)	31.3
RespiratoryExchangeRatio	0.690
OxygenConsumptionRate(mL/min)	350
CarbonDioxideProductionRate(mL/min)	241
GlomerularFiltrationRate(mL/min)	46.5
RenalBloodFlow(L/min)	1.20
UrineProductionRate(mL/min)	1.65
LeftAfferentArterioleResistance(mmHg_min/mL)	0.0367
RightAfferentArterioleResistance(mmHg_min/mL)	0.0367
SystemicVascularResistance(mmHg_s/mL)	0.520
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)	123
Trachea-CarbonDioxide-PartialPressure(mmHg)	27.6
LeftLungPulmonary-Oxygen-PartialPressure(mmHg)	123
RightLungPulmonary-Oxygen-PartialPressure(mmHg)	122
LeftLungPulmonary-CarbonDioxide-PartialPressure(mmHg)	28.0
RightLungPulmonary-CarbonDioxide-PartialPressure(mmHg)	28.5
LeftAlveoli-Oxygen-PartialPressure(mmHg)	123
LeftAlveoli-CarbonDioxide-PartialPressure(mmHg)	28.0
RightAlveoli-Oxygen-PartialPressure(mmHg)	122
RightAlveoli-CarbonDioxide-PartialPressure(mmHg)	28.5
Aorta-Oxygen-PartialPressure(mmHg)	88.8
Aorta-CarbonDioxide-PartialPressure(mmHg)	29.0
VenaCava-Oxygen-PartialPressure(mmHg)	31.1
VenaCava-CarbonDioxide-PartialPressure(mmHg)	39.3
RightTubules-Sodium-Concentration(g/L)	4.93
LeftTubules-Sodium-Concentration(g/L)	4.93
Oxygen-AlveolarTransfer(mL/min)	345
CarbonDioxide-AlveolarTransfer(mL/min)	-334
Epinephrine-BloodConcentration(ug/L)	0.0363
Epinephrine-SystemicMassCleared(ug)	95.2
Norepinephrine-BloodConcentration(ug/L)	0.185
Norepinephrine-SystemicMassCleared(ug)	328

Segment 3

Run for 4 hrs.

Table 5. Data request validation results for Segment 3.

Property Name	Validation	Engine Value	Percent Change	Notes
UrineProductionRate(mL/min)	GreaterThanEqualTo Segment2 (1.65) [14] [15]	1.89	15.15%	Increase or no change
CardiacOutput(L/min)	GreaterThanEqualTo Segment2 (10.1) [14] [15]	10.6	5.20%	Increase or no change
HeartStrokeVolume(mL)	GreaterThanEqualTo Segment2 (348) [14]	496	42.56%	Increase or no change
CentralVenousPressure(mmHg)	GreaterThanEqualTo Segment2 (12.8) [15]	16.2	25.69%	Increase or no change
MeanArterialPressure(mmHg)	GreaterThanEqualTo Segment2 (99.8) [15]	101	0.94%	Increase or no change

Figure 4. Vitals monitor for Segment 3.

Table 6. Data requests for Segment 3.

Property Name	Engine Value
Patient-Weight(kg)	80.9
ECG-Lead3ElectricPotential(mV)	0.0980
HeartRate(1/min)	21.4
HeartStrokeVolume(mL)	496
HeartEjectionFraction	0.891
BloodVolume(L)	12.7
ExtravascularFluidVolume(L)	34.0
ArterialPressure(mmHg)	55.1
MeanArterialPressure(mmHg)	101
SystolicArterialPressure(mmHg)	211
DiastolicArterialPressure(mmHg)	37.3
CardiacOutput(L/min)	10.6
HemoglobinContent(g)	822
CentralVenousPressure(mmHg)	16.2
PulmonaryCapillariesWedgePressure(mmHg)	27.5
TidalVolume(mL)	628
TotalLungVolume(mL)	2.35e+03
RespirationRate(1/min)	18.0
OxygenSaturation	0.982
CarbonDioxideSaturation	0.0307
EndTidalCarbonDioxideFraction	0.0343
EndTidalCarbonDioxidePressure(mmHg)	26.2
TotalAlveolarVentilation(L/min)	8.55
TranspulmonaryPressure(cmH2O)	22.1
CoreTemperature(degC)	36.7
SkinTemperature(degC)	30.9
RespiratoryExchangeRatio	0.676
OxygenConsumptionRate(mL/min)	326
CarbonDioxideProductionRate(mL/min)	220
GlomerularFiltrationRate(mL/min)	-6.97
RenalBloodFlow(L/min)	0.687
UrineProductionRate(mL/min)	1.89
LeftAfferentArterioleResistance(mmHg_min/mL)	0.0367
RightAfferentArterioleResistance(mmHg_min/mL)	0.0367
SystemicVascularResistance(mmHg_s/mL)	0.478
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)	139
Trachea-CarbonDioxide-PartialPressure(mmHg)	16.5
LeftLungPulmonary-Oxygen-PartialPressure(mmHg)	123
RightLungPulmonary-Oxygen-PartialPressure(mmHg)	122
LeftLungPulmonary-CarbonDioxide-PartialPressure(mmHg)	27.7
RightLungPulmonary-CarbonDioxide-PartialPressure(mmHg)	28.1
LeftAlveoli-Oxygen-PartialPressure(mmHg)	123
LeftAlveoli-CarbonDioxide-PartialPressure(mmHg)	27.8
RightAlveoli-Oxygen-PartialPressure(mmHg)	121
RightAlveoli-CarbonDioxide-PartialPressure(mmHg)	28.3
Aorta-Oxygen-PartialPressure(mmHg)	89.3
Aorta-CarbonDioxide-PartialPressure(mmHg)	27.6
VenaCava-Oxygen-PartialPressure(mmHg)	28.8
VenaCava-CarbonDioxide-PartialPressure(mmHg)	36.3
RightTubules-Sodium-Concentration(g/L)	5.26
LeftTubules-Sodium-Concentration(g/L)	5.26
Oxygen-AlveolarTransfer(mL/min)	261
CarbonDioxide-AlveolarTransfer(mL/min)	-243
Epinephrine-BloodConcentration(ug/L)	0.0363
Epinephrine-SystemicMassCleared(ug)	142
Norepinephrine-BloodConcentration(ug/L)	0.181
Norepinephrine-SystemicMassCleared(ug)	489

Scenario Output Plots

Figure 5. Select outputs from the scenario.