Base deficit and lactate: Early predictors of morbidity and mortality in patients with burns D. Andel a , L.-P. Kamolz b, *, J. Roka b , W. Schramm a , M. Zimpfer a , M. Frey b , H. Andel a a Department of Anesthesia and Intensive Care, Medical University Vienna, Vienna, Austria b Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria 1. Introduction Severe burn results in rapid loss of intravascular volume due to development of a severe capillary leak [1]. Burn shock is initially hypovolemic in nature and is characterized by profound hemodynamic changes including decreased plasma volume, cardiac output, urinary output with consecutively increased systemic vascular resistance resulting in dimin- ished peripheral blood flow [2]. Historically, resuscitation of trauma and surgical critical care patients is guided by a combination of basic laboratory values, invasive monitoring and clinical findings [3–5]. Increasing resuscitation volume will lead to increased interstitial edema due to the capillary leak, thereby further deteriorating microcirculation [6]. There- fore, the optimal guide to the endpoint of resuscitation still remains controversial. Ideal markers of adequate resuscita- tion should detect under infusion as well as excessive infusion by monitoring tissue hypoxia; moreover, they should be predictive of patient mortality and outcome. Although not unanimously accepted, abnormal plasma lactate (PL) and burns 33 (2007) 973–978 article info Article history: Accepted 29 June 2007 Keywords: Lactate Base deficit Outcome Morbidity Mortality abstract Severe burn results in severe and unique physiological changes called burn shock. Histori- cally, resuscitation has been guided by a combination of basic laboratory values, invasive monitoring and clinical findings, but the optimal guide to the endpoint of resuscitation still remains controversial. Two hundred and eighty patients, who were admitted to our Burn Unit, were enrolled in this prospective study. Resuscitation of these patients was under- taken according to the current standard of care. Parkland formula was used as a first approximation of acquired fluid administration rates; final fluid administration was adapted in order to meet clinical needs. The aim of this study was to evaluate if plasma lactate (PL) and base deficit (BD) are useful early parameters to estimate the severity of a burn. One of the main objectives was to evaluate if BD and its changes due to fluid resuscitation adds additional information in comparison to the evaluation of PL alone. The results of this study indicate that initial PL and BD level (Day 0) are useful parameters to separate survivors from non-survivors. Moreover, an outcome predictor of shock and effective resuscitation could be defined by evaluating the changes of BD on Day 1. Normalization of the BD within 24 h is associated with a better chance of survival. One explanation for this phenomenon might be the fact that many burn patients are still sub-optimally resuscitated; in summary, measuring PL and BD may help to identify critically injured patients either for enhancement of treatment, or selection of therapeutic options. # 2007 Elsevier Ltd and ISBI. All rights reserved. * Corresponding author. E-mail address: lars-peter.kamolz@meduniwien.ac.at (L.-P. Kamolz). available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/burns 0305-4179/$32.00 # 2007 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2007.06.016