In addition, the Army Burn Center serves as the regional burn center Wortmannin cost for all of South Texas, covering an area of 80,000 square miles with a population approaching five million.Prior to November 2005, only conventional intermittent hemodialysis (IHD) was available as a renal replacement modality for those who developed AKI. Strict traditional criteria such as profound hyperkalemia, symptomatic uremia, refractory fluid overload, and refractory acidosis were used to determine the need for IHD. In addition, many patients were considered to be poor candidates for IHD because of the presence of hemodynamic instability and thus not offered therapy. In this population, continuous venovenous hemofiltration (CVVH) seemed to be an attractive and necessary modality because it is well tolerated by hemodynamically unstable patients and allows for optimal metabolic management.

Thus, an intensivist-driven CVVH program was developed for our Burn Intensive Care Unit (BICU). We hypothesized that early intervention with CVVH in severely burned patients with AKI would result in better outcomes when compared with the traditional approach. Data on its impact on military casualties has previously been reported [5]. This study was conducted to expand the analysis to include all civilian patients treated in our BICU.Materials and methodsPatientsAfter obtaining approval from our hospital Institutional Review Board, we conducted a retrospective cohort study.

Consecutive severely burned patients, with more than 40% total body surface area (TBSA) with AKI who were initiated on CVVH between November 2005 and August 2007 were compared with closely matched historical controls identified prior to the availability of CVVH in the BICU (March 2003 to November 2005). Inclusion criteria for the control group included a diagnosis of acute renal failure, an injury severity score (ISS) of more than 25 and a burn size of more than 40% TBSA. First a list of all patients with a diagnosis of ‘renal failure’ or ‘renal insufficiency’ appearing on their electronic medical record was cross-matched with a list of all patients with an ISS of more than 25. Second, a query of all those in whom nephrology consultation was requested was performed and those patients not on the initial query were added. Finally, a query of all patients with a diagnosis of more than 40% TBSA was generated and a chart review of all patients not on the initial two queries performed in order to identify patients meeting the diagnosis of AKI (Acute Kidney Injury Network (AKIN) stage 2 or greater) that did not have it documented on their list of diagnoses. In both groups, those patients who were moribund (who lived less than 12 hours) or had Carfilzomib the diagnosis of chronic renal insufficiency were excluded.