Brief Report
Comparison of hypertonic vs isotonic fluids during resuscitation of severely burned patients

https://doi.org/10.1016/j.ajem.2008.08.008Get rights and content

Abstract

Background

The hypertonic lactate saline (HLS) solutions with mild concentration of sodium have been used in some burn centers to maintain plasma volume without infusing larger fluids volumes. To evaluate the fluid requirements during resuscitation with lactated Ringer's solution and to realize resuscitation with HLS, we suggest the following clinical trial. Specific objectives include fluid loads, sodium loads, and fluid accumulation.

Method

This prospective study included 110 patients with severe burns. The first group included patients resuscitated in the beginning with lactated Ringer's solution, according to Parkland formula for adults and Shriner formula for children. In the other group, the patients were resuscitated with HLS solution. Patients are divided in 2 groups for comparison.

Results

There is difference between sodium loads (P = .03), fluid load in the first hour (P = .001), sodium load in the first hour (P = .001), and net fluid accumulation (P = .0025). There is a difference regarding plasma sodium and plasma osmolality in the first hour (P = .003, P = .002). There is difference regarding sodium given (P = .001) and sodium excreted (P = .001) in 2 groups.

Conclusions

Hypertonic resuscitation consists in giving a higher fluid and sodium load in the first hour of therapy that is accompanied with a decrease in fluid requirements and fluid accumulation for the first 24 hours of burn shock.

Introduction

The primary goal for severely burned patients' resuscitation is the maintenance of organ perfusion to prevent ischemia and to restore the deficit in sodium lost from the extracellular space [1], [2]. As Warden wrote [3], each resuscitation formula properly used can be effective in burn patient resuscitation.

Since the establishment of our service, the resuscitation formulas used are Parkland formula for adults and Shriner's Galveston for burned children [3]. From our previous studies, we have noticed that the fluid requirements for resuscitation have been in conformity with or higher than what are recommended. Thus, the fluid requirements have ranged from 3.9 to 4.7 mL kg−1 % body surface area (BSA)−1[4], [5], whereas in some cases, the resuscitation was made with 37% more than theoretical values foreseen by formulas [4].

To evaluate the fluid requirements during resuscitation, which means to compare the estimated and actual fluid volume using isotonic resuscitation with lactated Ringer's (LR) solution and to realize resuscitation with hypertonic lactate saline (HLS), we suggest the following clinical trial. The HLS solutions with mild concentration of sodium (250 mEq/L) have been used in some burn centers to replenish and maintain plasma volume without infusing larger volumes of fluid [6].

Our main research issue is to compare the fluid balance during resuscitation of burn patients, using LR and HLS.

Section snippets

Methods

This is a prospective study evaluating the fluid resuscitation with different regimens.

Results

During a 2-year period, a total of 110 patients are included in the study. The demographic and clinical groups' baselines are presented in Table 1. There is no statistically significant difference in patient characteristics. There are 55 patients analyzed for each group: 50 alive and 5 dead. So the mortality was 9% in each group. None of the deaths occurred in the period of resuscitation (mean time of deaths, 11 ± 3 days). Deaths in both groups are related to septic shock. A summary of fluid

Discussion

As was mentioned before, the purpose of this study is to realize resuscitation with HLS and to compare the fluid balance in isotonic and hypertonic groups. In our previous studies, in many cases, we have done a standard isotonic resuscitation according to Parkland formula without modifications given larger fluids amounts [5].

In this study, the patients of isotonic group are resuscitated according to formulas too. The main difference is that we try to be more careful during monitoring, and not

Acknowledgments

The authors thank the medical staff of the Service of Burns near University Hospital Center “Mother Teresa” in Tirana, Albania, for the support on realization of this study. The authors gratefully thank the Chief of the Department of Surgery Prof Nikollaq Kacani for helpful comments and support of the manuscript.

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