Blindness Following Severe Burn in Fluid Overresuscitated Patients
Supervisor / Principle Investigator:
Dr. Edward Tredget
MD Class of 2020
Introduction: Blindness is a rare yet devastating consequence of fluid overresuscitation in severe burn patients. Fluid overresuscitation is thought to raise intraocular pressure (IOP), subsequently resulting in tissue ischemia and vision loss. Monitoring of IOP in severe burn patients is becoming increasingly routine at large burn institutions.
Methods: This is a retrospective review of two burn patients treated at the University of Alberta burn center who experienced blindness. Neither patient had previous visual defects. Both patients went bilaterally blind with no documented vision since recovered. Each patient’s chart was analyzed for fluid input and output at 24/48/72/96 hours post-accident. A percent of predicted fluid intake based on Parkland’s formula was calculated. Total opioids and sedatives administered up to the first 96 hours were further noted.
Results: Patient 1 sustained 65% TBSA burn injuries. He received over 41L (144 % predicted) of crystalloids in the first 24 hours. The patient experienced blindness 72-96 hours post-accident. Patient 2 sustained 90% TBSA burn injuries. He received over 37L (106 % predicted) of crystalloids in the first 24 hours. He experienced blindness on day 84 post-accident. Our results indicate both patients were overrescusitated. Further, both patients were heavily sedated post-accident.
Conclusion: Fluids should be titrated and patients should be weened off opioids and sedatives as early as possible in the treatment course to avoid delaying the identification and negative sequalae of fluid overresuscitation. Applicability: Since these two case studies, it has become protocol at the University of Alberta to measure the IOP of severe burn patients. Literature has shown that interventions such as lateral cantholysis can reduce IOP and prevent blindness.