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The U.S. Department of Defense has funded research into the potential benefits of providing supplemental oral fluids to patients with burn injuries rather than via intravenous (IV).
Burns cause a tremendous loss of body fluids. Therefore, burn resuscitation is the essential treatment step of replacing lost fluids, typically through an IV. Without it, burns can be fatal. The sooner this process begins after a burn, the better the patient’s outcomes will be.
Yet, in many parts of the world and even in some parts of this country, there aren’t enough supplies to give fluids through an IV, and doctors must provide necessary fluids by mouth.
A quality improvement project underway at MedStar Health Research Institute and a related multicenter research study funded by the U.S. Department of Defense (DOD) will aim to determine whether giving fluids orally—known as enteral fluid resuscitation—could reduce reliance on IV fluid for civilian and active military patients with burn injuries.
Our research has been continuously funded by the DoD since 2010. The Burn Center at MedStar Washington Hospital Center has earned a reputation as the civilian organization that can answer military-relevant questions to help improve care and conduct innovative research that benefits all our patients.
How does burn resuscitation help patients heal?
More than 95% of burns occur in low- and middle-income countries. Resuscitation helps to replace fluids lost during a burn injury. Replenishing the body’s fluids helps work against hypovolemia (too little fluid, including water and blood) and hypoperfusion, or shock (too few nutrients and too little oxygen reaching the tissues). These are part of the body’s response to a burn of 20% or more of its surface area and can be fatal.
In the U.S., patients needing burn resuscitation typically get Ringer’s Lactated (RL) solution through an IV. RL contains sodium, chloride, potassium, calcium, and lactate in water to replace electrolytes and fluids in the body. However, in many low- or middle-income countries—where more than 95% of burns occur. IV catheters, bags, and RL are often in short supply.
Doctors often use Oral Rehydration Solutions (ORS) made with clean water, salt, and sugar in these cases. The patient drinks the fluid, which enters their body through the gastrointestinal system. Studies have shown that this method, called enteral fluid resuscitation, can be successful in burns covering up to 40% of the body’s surface area.
My colleagues and I, who have participated in global surgery initiatives, have been impressed by the effectiveness of enteral resuscitation, so we decided to try to understand how this method could benefit patients in the U.S. and beyond.
Related reading: 12 Ways to Care for and Prevent Burns.
Answering questions about enteral resuscitation.
In 2023, we began a quality improvement project in which participants were given supplemental ORS through a nasal tube or mouth. We’re monitoring them closely to answer questions such as:
- Does supplemental ORS reduce the amount of IV fluid needed for resuscitation?
- Can enteral resuscitation reduce the time it takes to provide treatment?
- Does providing fluids orally lead to decreased inflammation?
- Do blood vessels leak less fluid, and how does that impact the microbiome of patients?
- Does enteral fluid resuscitation impact infection risk?
The DOD sought out our team to help them understand whether ORS might be functional for active military members in areas where RL is less available. They’ve provided funding for a clinical trial that will follow our quality improvement project in collaboration with colleagues from the University Medical Center in New Orleans.
This work will have benefits beyond that battlefield, as well. In some remote parts of the U.S., burn centers are few and far between. Beginning resuscitation with ORS while they’re on the way to treatment could increase burn survival rates and improve outcomes. The same could be true for mass casualty events, with patient needs that exceed available treatment resources.
Related reading: New Research Aims to Help Restore Skin Pigment in Burn Scars.
More than 50 years of burn care innovation.
For more than 50 years, The Burn Center has provided integrated, multidisciplinary care and leading research. Our focus on continual innovation in patient care means we’re always finding new ways to provide better treatments that improve our patients’ lives.
Our collaborative team of experts provides real-time precision medicine to every patient under our care. From burn resuscitation through rehabilitation, we work with each patient to tailor our response to their injury, and we’re always working to find new, better ways to help.
