Burn-NoResuscitation
NoResuscitation
Description
This scenario provides a qualitative comparison of human burn patients using data from swine experiments.
Paradigm 1: No IV fluids to under-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
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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 No IV. Run for 4 hrs.
| 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] | 16.0 | 0.00% | Ventilator protocol | |
| TidalVolume(mL) | [527,1.13e+03] [14] [15] | 531 | 0.00% | Ventilator protocol | |
| EndTidalCarbonDioxidePressure(mmHg) | [35.0,45.0] [14] [15] | 47.9 | 6.50% | Ventilator protocol | |
| UrineProductionRate(mL/min) | LessThan Baseline (0.929) [14] [15] | 0.122 | -86.89% | Decrease | |
| CardiacOutput(L/min) | LessThan Baseline (5.78) [14] [15] | 6.07 | 5.11% | Decrease | |
| HeartStrokeVolume(mL) | LessThan Baseline (80.2) [14] | 64.4 | -19.68% | Decrease | |
| CentralVenousPressure(mmHg) | LessThan Baseline (4.80) [15] | 4.69 | -2.34% | Decrease | |
| MeanArterialPressure(mmHg) | LessThan Baseline (95.3) [15] | 96.2 | 1.00% | Decrease |
 |
| Property Name | Engine Value |
|---|---|
| Patient-Weight(kg) | 76.3 |
| ECG-Lead3ElectricPotential(mV) | -0.0500 |
| HeartRate(1/min) | 94.3 |
| HeartStrokeVolume(mL) | 64.4 |
| HeartEjectionFraction | 0.509 |
| BloodVolume(L) | 5.27 |
| ExtravascularFluidVolume(L) | 33.4 |
| ArterialPressure(mmHg) | 112 |
| MeanArterialPressure(mmHg) | 96.2 |
| SystolicArterialPressure(mmHg) | 112 |
| DiastolicArterialPressure(mmHg) | 79.3 |
| CardiacOutput(L/min) | 6.07 |
| HemoglobinContent(g) | 821 |
| CentralVenousPressure(mmHg) | 4.69 |
| PulmonaryCapillariesWedgePressure(mmHg) | 5.68 |
| TidalVolume(mL) | 531 |
| TotalLungVolume(mL) | 2.20e+03 |
| RespirationRate(1/min) | 16.0 |
| OxygenSaturation | 0.933 |
| CarbonDioxideSaturation | 0.295 |
| EndTidalCarbonDioxideFraction | 0.0627 |
| EndTidalCarbonDioxidePressure(mmHg) | 47.9 |
| TotalAlveolarVentilation(L/min) | 6.06 |
| TranspulmonaryPressure(cmH2O) | 10.3 |
| CoreTemperature(degC) | 37.3 |
| SkinTemperature(degC) | 29.2 |
| RespiratoryExchangeRatio | 0.693 |
| OxygenConsumptionRate(mL/min) | 386 |
| CarbonDioxideProductionRate(mL/min) | 268 |
| GlomerularFiltrationRate(mL/min) | 87.0 |
| RenalBloodFlow(L/min) | 0.976 |
| UrineProductionRate(mL/min) | 0.122 |
| LeftAfferentArterioleResistance(mmHg_min/mL) | 0.0987 |
| RightAfferentArterioleResistance(mmHg_min/mL) | 0.0987 |
| SystemicVascularResistance(mmHg_s/mL) | 0.904 |
| 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) | 95.8 |
| Trachea-CarbonDioxide-PartialPressure(mmHg) | 48.0 |
| LeftLungPulmonary-Oxygen-PartialPressure(mmHg) | 94.0 |
| RightLungPulmonary-Oxygen-PartialPressure(mmHg) | 91.6 |
| LeftLungPulmonary-CarbonDioxide-PartialPressure(mmHg) | 49.5 |
| RightLungPulmonary-CarbonDioxide-PartialPressure(mmHg) | 49.9 |
| LeftAlveoli-Oxygen-PartialPressure(mmHg) | 94.0 |
| LeftAlveoli-CarbonDioxide-PartialPressure(mmHg) | 49.6 |
| RightAlveoli-Oxygen-PartialPressure(mmHg) | 91.5 |
| RightAlveoli-CarbonDioxide-PartialPressure(mmHg) | 49.9 |
| Aorta-Oxygen-PartialPressure(mmHg) | 69.4 |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | 49.1 |
| VenaCava-Oxygen-PartialPressure(mmHg) | 34.0 |
| VenaCava-CarbonDioxide-PartialPressure(mmHg) | 55.1 |
| RightTubules-Sodium-Concentration(g/L) | 6.34 |
| LeftTubules-Sodium-Concentration(g/L) | 6.34 |
| Oxygen-AlveolarTransfer(mL/min) | 370 |
| CarbonDioxide-AlveolarTransfer(mL/min) | -78.3 |
| Epinephrine-BloodConcentration(ug/L) | 0.0378 |
| Epinephrine-SystemicMassCleared(ug) | 47.3 |
| Norepinephrine-BloodConcentration(ug/L) | 0.225 |
| Norepinephrine-SystemicMassCleared(ug) | 161 |
Segment 2
Run for 4 hrs.
| Property Name | Validation | Engine Value | Percent Error | Percent Change | Notes |
|---|---|---|---|---|---|
| UrineProductionRate(mL/min) | EqualTo Segment1 (0.122) [14] [15] | 0.0393 | -67.73% | No change | |
| CardiacOutput(L/min) | EqualTo Segment1 (6.07) [14] [15] | 6.01 | -1.00% | No change | |
| HeartStrokeVolume(mL) | EqualTo Segment1 (64.4) [14] | 66.1 | 2.63% | No change | |
| CentralVenousPressure(mmHg) | EqualTo Segment1 (4.69) [15] | 4.33 | -7.66% | No change | |
| MeanArterialPressure(mmHg) | EqualTo Segment1 (96.2) [15] | 96.2 | -0.02% | No change |
 |
| Property Name | Engine Value |
|---|---|
| Patient-Weight(kg) | 76.1 |
| ECG-Lead3ElectricPotential(mV) | 0.0980 |
| HeartRate(1/min) | 90.9 |
| HeartStrokeVolume(mL) | 66.1 |
| HeartEjectionFraction | 0.517 |
| BloodVolume(L) | 5.08 |
| ExtravascularFluidVolume(L) | 33.4 |
| ArterialPressure(mmHg) | 98.2 |
| MeanArterialPressure(mmHg) | 96.2 |
| SystolicArterialPressure(mmHg) | 112 |
| DiastolicArterialPressure(mmHg) | 78.7 |
| CardiacOutput(L/min) | 6.01 |
| HemoglobinContent(g) | 821 |
| CentralVenousPressure(mmHg) | 4.33 |
| PulmonaryCapillariesWedgePressure(mmHg) | 5.74 |
| TidalVolume(mL) | 531 |
| TotalLungVolume(mL) | 2.21e+03 |
| RespirationRate(1/min) | 16.0 |
| OxygenSaturation | 0.937 |
| CarbonDioxideSaturation | 0.333 |
| EndTidalCarbonDioxideFraction | 0.0648 |
| EndTidalCarbonDioxidePressure(mmHg) | 49.5 |
| TotalAlveolarVentilation(L/min) | 6.06 |
| TranspulmonaryPressure(cmH2O) | 10.1 |
| CoreTemperature(degC) | 37.3 |
| SkinTemperature(degC) | 29.3 |
| RespiratoryExchangeRatio | 0.695 |
| OxygenConsumptionRate(mL/min) | 401 |
| CarbonDioxideProductionRate(mL/min) | 279 |
| GlomerularFiltrationRate(mL/min) | 62.2 |
| RenalBloodFlow(L/min) | 0.794 |
| UrineProductionRate(mL/min) | 0.0393 |
| LeftAfferentArterioleResistance(mmHg_min/mL) | 0.113 |
| RightAfferentArterioleResistance(mmHg_min/mL) | 0.113 |
| SystemicVascularResistance(mmHg_s/mL) | 0.917 |
| 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) | 94.3 |
| Trachea-CarbonDioxide-PartialPressure(mmHg) | 49.4 |
| LeftLungPulmonary-Oxygen-PartialPressure(mmHg) | 93.5 |
| RightLungPulmonary-Oxygen-PartialPressure(mmHg) | 91.5 |
| LeftLungPulmonary-CarbonDioxide-PartialPressure(mmHg) | 50.3 |
| RightLungPulmonary-CarbonDioxide-PartialPressure(mmHg) | 50.7 |
| LeftAlveoli-Oxygen-PartialPressure(mmHg) | 93.5 |
| LeftAlveoli-CarbonDioxide-PartialPressure(mmHg) | 50.3 |
| RightAlveoli-Oxygen-PartialPressure(mmHg) | 91.5 |
| RightAlveoli-CarbonDioxide-PartialPressure(mmHg) | 50.7 |
| Aorta-Oxygen-PartialPressure(mmHg) | 72.0 |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | 50.6 |
| VenaCava-Oxygen-PartialPressure(mmHg) | 34.9 |
| VenaCava-CarbonDioxide-PartialPressure(mmHg) | 57.3 |
| RightTubules-Sodium-Concentration(g/L) | 7.00 |
| LeftTubules-Sodium-Concentration(g/L) | 7.00 |
| Oxygen-AlveolarTransfer(mL/min) | 465 |
| CarbonDioxide-AlveolarTransfer(mL/min) | -525 |
| Epinephrine-BloodConcentration(ug/L) | 0.0381 |
| Epinephrine-SystemicMassCleared(ug) | 92.2 |
| Norepinephrine-BloodConcentration(ug/L) | 0.228 |
| Norepinephrine-SystemicMassCleared(ug) | 315 |
Segment 3
Run for 4 hrs.
| Property Name | Validation | Engine Value | Percent Error | Percent Change | Notes |
|---|---|---|---|---|---|
| UrineProductionRate(mL/min) | EqualTo Segment2 (0.0393) [14] [15] | 2.38e-19 | -100.00% | No change | |
| CardiacOutput(L/min) | EqualTo Segment2 (6.01) [14] [15] | 5.88 | -2.13% | No change | |
| HeartStrokeVolume(mL) | EqualTo Segment2 (66.1) [14] | 60.1 | -9.10% | No change | |
| CentralVenousPressure(mmHg) | EqualTo Segment2 (4.33) [15] | 4.07 | -5.99% | No change | |
| MeanArterialPressure(mmHg) | EqualTo Segment2 (96.2) [15] | 96.0 | -0.24% | No change |
 |
| Property Name | Engine Value |
|---|---|
| Patient-Weight(kg) | 76.0 |
| ECG-Lead3ElectricPotential(mV) | -0.0751 |
| HeartRate(1/min) | 97.9 |
| HeartStrokeVolume(mL) | 60.1 |
| HeartEjectionFraction | 0.495 |
| BloodVolume(L) | 4.92 |
| ExtravascularFluidVolume(L) | 33.4 |
| ArterialPressure(mmHg) | 102 |
| MeanArterialPressure(mmHg) | 96.0 |
| SystolicArterialPressure(mmHg) | 111 |
| DiastolicArterialPressure(mmHg) | 80.0 |
| CardiacOutput(L/min) | 5.88 |
| HemoglobinContent(g) | 821 |
| CentralVenousPressure(mmHg) | 4.07 |
| PulmonaryCapillariesWedgePressure(mmHg) | 5.41 |
| TidalVolume(mL) | 531 |
| TotalLungVolume(mL) | 2.29e+03 |
| RespirationRate(1/min) | 16.0 |
| OxygenSaturation | 0.928 |
| CarbonDioxideSaturation | 0.373 |
| EndTidalCarbonDioxideFraction | 0.0670 |
| EndTidalCarbonDioxidePressure(mmHg) | 51.2 |
| TotalAlveolarVentilation(L/min) | 6.06 |
| TranspulmonaryPressure(cmH2O) | 9.52 |
| CoreTemperature(degC) | 37.4 |
| SkinTemperature(degC) | 29.4 |
| RespiratoryExchangeRatio | 0.693 |
| OxygenConsumptionRate(mL/min) | 407 |
| CarbonDioxideProductionRate(mL/min) | 282 |
| GlomerularFiltrationRate(mL/min) | 59.9 |
| RenalBloodFlow(L/min) | 0.774 |
| UrineProductionRate(mL/min) | 2.38e-19 |
| LeftAfferentArterioleResistance(mmHg_min/mL) | 0.131 |
| RightAfferentArterioleResistance(mmHg_min/mL) | 0.131 |
| SystemicVascularResistance(mmHg_s/mL) | 0.937 |
| 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) | 93.0 |
| Trachea-CarbonDioxide-PartialPressure(mmHg) | 50.5 |
| LeftLungPulmonary-Oxygen-PartialPressure(mmHg) | 93.2 |
| RightLungPulmonary-Oxygen-PartialPressure(mmHg) | 91.1 |
| LeftLungPulmonary-CarbonDioxide-PartialPressure(mmHg) | 50.8 |
| RightLungPulmonary-CarbonDioxide-PartialPressure(mmHg) | 51.3 |
| LeftAlveoli-Oxygen-PartialPressure(mmHg) | 93.2 |
| LeftAlveoli-CarbonDioxide-PartialPressure(mmHg) | 50.8 |
| RightAlveoli-Oxygen-PartialPressure(mmHg) | 91.1 |
| RightAlveoli-CarbonDioxide-PartialPressure(mmHg) | 51.3 |
| Aorta-Oxygen-PartialPressure(mmHg) | 69.8 |
| Aorta-CarbonDioxide-PartialPressure(mmHg) | 52.3 |
| VenaCava-Oxygen-PartialPressure(mmHg) | 34.8 |
| VenaCava-CarbonDioxide-PartialPressure(mmHg) | 60.3 |
| RightTubules-Sodium-Concentration(g/L) | 7.80 |
| LeftTubules-Sodium-Concentration(g/L) | 7.80 |
| Oxygen-AlveolarTransfer(mL/min) | 357 |
| CarbonDioxide-AlveolarTransfer(mL/min) | 91.1 |
| Epinephrine-BloodConcentration(ug/L) | 0.0386 |
| Epinephrine-SystemicMassCleared(ug) | 137 |
| Norepinephrine-BloodConcentration(ug/L) | 0.231 |
| Norepinephrine-SystemicMassCleared(ug) | 468 |
Scenario Output Plots
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