Albumin administration for fluid resuscitation in burn patients: A systematic review and meta-analysis

Eljaiek, Roberto; Heylbroeck, Christophe; Dubois, Marc-Jacques

doi:10.1016/j.burns.2016.08.001

Cited by 60 publications

(27 citation statements)

References 24 publications

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“…A systematic review by Dubois in 2017 looking at albumin administration during the fluid resuscitation phase of burn patients and mortality found a paucity of high‐quality studies looking at albumin or FFP. The authors concluded that there was limited evidence in the literature and no high quality trial to assess the impact of albumin solutions on the mortality of burn patients . There remains no high‐quality evidence supporting or refuting the use of FFP as a resuscitation product in burn patients.…”

Section: Shift To Crystalloidsmentioning

confidence: 99%

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Plasma for burn shock resuscitation: is it time to go back to the future?

2019

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Patients with burn shock can be challenging to resuscitate. Burn shock produces a variety of physiologic derangements: Patients are hypovolemic from volume loss, have a increased systemic vascular resistance, and may have a depressed cardiac output depending on the extent of the thermal injury. Additionally, the burn wound produces a significant inflammatory cascade of events that contributes to the shock state. Fluid resuscitation is foundational for the initial treatment of burn shock. Typical resuscitation is with intravenous lactated Ringer's in accordance with well‐established formulas based on burn wound size. In the past century, as therapies to treat thermal injuries were being developed, plasma was the fluid used for burn resuscitation; in fact, plasma was used in World War II and throughout the 1950s and 1960s. Plasma was abandoned because of infectious risks and complications. Despite huge strides in transfusion medicine and the increased safety of blood products, plasma has never been readopted for burn resuscitation. Over the past 15 years, there has been a paradigm shift in trauma resuscitation: Less crystalloid and more blood products are used; this strategy has demonstrated improved outcomes. Plasma is a physiologic fluid that stabilizes the endothelium. The endotheliopathy of trauma has been described and is mitigated by transfusion strategies with a 1:1 ratio of RBCs to plasma. Thermal injury also results in endothelial dysfunction: the endotheliopathy of burns. Plasma is likely a better resuscitation fluid for patients with significant burn wounds because of its capability to restore intravascular volume status and treat the endotheliopathy of burns.

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Section: Shift To Crystalloidsmentioning

confidence: 99%

“…The authors concluded that there was limited evidence in the literature and no high quality trial to assess the impact of albumin solutions on the mortality of burn patients. 76 There remains no high-quality evidence supporting or refuting the use of FFP as a resuscitation product in burn patients.…”

Section: Shift To Crystalloidsmentioning

confidence: 99%

Plasma for burn shock resuscitation: is it time to go back to the future?

2019

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“…[58,59] Another meta-analysis study reported that albumin was not beneficial. [60] Our study concluded that the use of albumin reduces mortality. Although our results were consistent with a small portion of the literature, it was found to be incompatible with most of the research works in literature.…”

Section: Administration Of the Albuminmentioning

confidence: 63%

Factors Affecting The Mortality At Patients With Burns: Single Centre Results

Temiz

Albayrak

Peksöz³

et al. 2020

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Burns are a primary cause of mortality along with the severe physical and psychological morbidities in patients and their families. Such kinds of injuries bring about considerable financial burdens due to the treatment processes and sequels. The present study aims to investigate the factors that affect the mortality of burns. METHODS: The archives files of the patients admitted because of burn injuries in our burn centre between September 2008 and December 2016 were examined in this study. Some of the lab values, such as age, sex, percentage of total burn surface area (TBSA), referral status, burning site, degree of burns, time of admission to hospital, aetiology of burning, blood and blood products collection, complete blood count, routine biochemistry, coagulation parameters, C-reactive protein (CRP), sedimentation rate, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), were examined while evaluating the patients' mortalities. RESULTS: A total of 133 patients were included in this study. The patient's age (p=0.001), the degree of burns (p<0.001), surface area of burns (p<0.001), the time of hospital admission (p<0.001), burning aetiology (p=0.006), erythrocyte suspension, fresh frozen plasma, along with the administration of albumin transfusion (p<0.001), mean platelet volume (MPV) (p=0.028), NLR (p<0.001) and PLR (p<0.030) values were found to be associated with mortality in patients with burns. CONCLUSION: In this study, age, burn grade, TBSA, hospital admission time, burn aetiology, erythrocyte, fresh frozen plasma and albumin transfusion, MPV, NLR and PLR values were found to be associated with mortality in patients with burns. With this study, it is possible to produce the treatment guidelines to reduce mortality by taking these parameters into consideration, which were determined to be associated with mortality while evaluating the patients with burns.

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“…To account for differences in baseline characteristics between patients with and without high-dose vitamin C, we performed a propensity score analysis. A logistic regression model was performed to calculate propensity scores for patients receiving high-dose vitamin C, using the following patient background characteristics and interventions performed within 1 day of admission [11, 15, 22–25]: age, sex, burn index, presence of inhalation injury, CCI, JCS, use of vasopressor, albumin, hydroxyethyl starch, intravenous antibiotics, neuromuscular blockade, haptoglobin, transfusion (red blood cells, platelets, and fresh frozen plasma), mechanical ventilation, renal replacement therapy (RRT), implementation of pharyngolaryngeal/bronchial/gastrointestinal endoscopy, enteral feeding via nasogastric tube, inta-arterial blood pressure monitoring, utilization of intensive care unit, admission to teaching hospital, and transportation from another hospital. A one-to-four propensity score matching was next performed by nearest-neighbor matching with replacement.…”

Section: Methodsmentioning

confidence: 99%

Effect of high-dose vitamin C therapy on severe burn patients: a nationwide cohort study

et al. 2019

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BackgroundVitamin C is a well-documented antioxidant that reduces oxidative stress and fluid infusion in high doses; however, the association between high-dose vitamin C and reduced mortality remains unclear. This study evaluates the effect of high-dose vitamin C in severe burn patients under two varying thresholds.MethodsWe enrolled adult patients with severe burns (burn index ≥ 15) who were registered in the Japanese Diagnosis Procedure Combination national inpatient database from 2010 to 2016. Propensity score matching was performed between patients who received high-dose vitamin C within 1 day of admission (vitamin C group) and those who did not (control group). High-dose vitamin C was defined as a dosage in excess of 10 g or 24 g within 2 days of admission. The primary outcome was in-hospital mortality.ResultsEligible patients (n = 2713) were categorized into the vitamin C group (n = 157) or control group (n = 2556). After 1:4 propensity score matching, we compared 157 and 628 patients who were administered high-dose vitamin C (> 10-g threshold) and controls, respectively. Under this particular threshold, high-dose vitamin C therapy was associated with reduced in-hospital mortality (risk ratio, 0.79; 95% confidence interval, 0.66–0.95; p = 0.006). In contrast, in-hospital mortality did not differ between the control and high-dose vitamin C group under the > 24-g threshold (risk ratio, 0.83; 95% confidence interval, 0.68–1.02; p = 0.068).ConclusionsHigh-dose vitamin C therapy was associated with reduced mortality in patients with severe burns when used under a minimum threshold of 10 g within the first 2 days of admission. While “high-dose” vitamin C therapy lacks a universal definition, the present study reveals that different “high-dose” regimens may yield improved outcomes.

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Albumin administration for fluid resuscitation in burn patients: A systematic review and meta-analysis

Cited by 60 publications

References 24 publications

Plasma for burn shock resuscitation: is it time to go back to the future?

Plasma for burn shock resuscitation: is it time to go back to the future?

Factors Affecting The Mortality At Patients With Burns: Single Centre Results

Effect of high-dose vitamin C therapy on severe burn patients: a nationwide cohort study

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