Brief ReportComparison of hypertonic vs isotonic fluids during resuscitation of severely burned patients
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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Cited by (18)
Hypertonic saline in critical illness - A systematic review
2017, Journal of Critical CareBurns management in ICU: Quality of the evidence: A systematic review
2016, BurnsCitation Excerpt :See Fig. 1, PRISMA 2009 flow diagram [14]. Of the included studies, 23 covered fluid resuscitation [15–37], 22 covered parenteral and enteral analgesia [38–59], nine addressed haemodynamic monitoring and targets [60–68] and two were on the topic of ventilation [69,70]. No studies on the topic of blood transfusion practice that met the inclusion criteria were found.
First resuscitation of critical burn patients: Progresses and problems
2016, Medicina IntensivaCitation Excerpt :Patients resuscitated with hypertonic sodium solutions required lower total volume than that of isotonic solutions in the initial 24 h, but after 48 h, cumulative fluid loads were similar. The use of hypertonic saline as a resuscitation fluid decreases the risk of abdominal compartment syndrome but does not appear to provide better outcomes than isotonic solutions and has been associated with increased rates of renal failure and death in one retrospective observational study.9 Colloids are more expensive, and in critically ill patients, do not improve survival when compared with crystalloids.10
Burns in children: Standard and new treatments
2014, The LancetCitation Excerpt :Fresh frozen plasma, which is used in patients with trauma, is not given to patients with burns because experimental and clinical trials assessing the efficacy of the fluid have not been done in this patient population. Hypertonic saline showed some promise in small studies of patients with burns,23 but failed to improve outcome in patients with traumatic brain injury.24 Resuscitation has profoundly evolved over the past two decades and will continue to do so, because the procedure has a central role in survival soon after burn.
New and Future Resuscitation Fluids for Trauma Patients Using Hemoglobin and Hypertonic Saline
2013, Anesthesiology ClinicsBurn management in disasters and humanitarian crises
2012, Total Burn Care: Fourth Edition