A clinical randomized study on the effects of invasive monitoring on burn shock resuscitation

Holm, Charlotte; Mayr, Martina; Tegeler, J.; Hörbrand, F.; Donnersmarck, G. Henckel von; Mühlbauer, W.; Pfeiffer, Ulrich J.

doi:10.1016/j.burns.2004.06.016

Cited by 157 publications

(89 citation statements)

References 23 publications

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“…Although goal-directed treatment has been advocated in septic patients in the past [16], recent data from the ProCESS study could not confirm this and, as such, this cannot be recommended in burn patients [17]. This is supported by previous reports showing that volumetric monitoring may lead to even higher resuscitation volumes and possible adverse effects [18].…”

supporting

confidence: 52%

“…The total circulating blood volume could be an ideal guide to resuscitation [39]. However, a previous study found goal-directed therapy by invasive monitoring, as compared to Baxter's empiric resuscitation formula, caused a significant increase in the volume of fluid administration but did not improve preload or cardiac output parameters [18]. Thus, managing the appropriate volumes of resuscitation fluid is challenging.…”

Section: Discussion Incidence Of Iah/acsmentioning

confidence: 99%

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Incidence and prognosis of intra-abdominal hypertension and abdominal compartment syndrome in severely burned patients: Pilot study and review of the literature

Wise

Jacobs²,

Pilate³

et al. 2016

Anaesthesiol Intensive Ther

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Background: Burn patients are at high risk for secondary intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) due to capillary leak and large volume fluid resuscitation. Our objective was to examine the incidence the incidence of IAH and ACS and their relation to outcome in mechanically ventilated (MV) burn patients. Methods: This observational study included all MV burn patients admitted between April 2007 and December 2009. Various physiological parameters, intra-abdominal pressure (IAP) measurements and severity scoring indices were recorded on admission and/or each day in ICU. Transpulmonary thermodilution parameters were also obtained in 23 patients. The mean and maximum IAP during admission was calculated. The primary endpoint was ICU (burn unit) mortality. Results: Fifty-six patients were included. The average Simplified Acute Physiology Score (SAPS II) and Sequential Organ Failure Assessment (SOFA) scores were 43.4 ± 15.1 and 6.4 ± 3.4, respectively. The average total body surface area (TBSA) affected by burns was 24.9% ( ± 24.9), with 33 patients suffering inhalational injuries. Forty-four (78.6%) patients developed IAH and 16 (28.6%) suffered ACS. Patients with ACS had higher TBSAs burned (35.8 ± 30 vs 20.6 ± 21.4%, P = 0.04) and higher cumulative fluid balances after 48 hours (13.6 ± 16L vs 7.6 ± 4.1L, P = 0.03). The TBSA burned correlated well with the mean IAP (R = 0.34, P = 0.01). Mortality was notably high (26.8%) and significantly higher in patients with IAH (34.1%, P = 0.014) and ACS (62.5%, P < 0.0001). Most patients received more fluids than calculated by the Parkland Consensus Formula while, interestingly, non-survivors received less. However, when patients with pure inhalation injury were excluded there were no differences. Non-surgical interventions (n = 24) were successful in removing body fluids and were related to a significant decrease in IAP, central venous pressure (CVP) and an improvement in oxygenation and urine output. Non-resolution of IAH was associated with a significantly worse outcome (P < 0.0001). Conclusion: Based on our preliminary results we conclude that IAH and ACS have a relatively high incidence in MV burn patients compared to other groups of critically ill patients. The percentage of TBSA burned correlates with the mean IAP. The combination of high CLI, positive (daily and cumulative) fluid balance, high IAP, high EVLWI and low APP suggest a poor outcome. Non-surgical interventions appear to improve end-organ function. Non-resolution of IAH is related to a worse outcome.

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supporting

confidence: 52%

Section: Discussion Incidence Of Iah/acsmentioning

confidence: 99%

Incidence and prognosis of intra-abdominal hypertension and abdominal compartment syndrome in severely burned patients: Pilot study and review of the literature

Wise

Jacobs²,

Pilate³

et al. 2016

Anaesthesiol Intensive Ther

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“…In addition, early goal-directed therapy has led to more aggressive fluid resuscitation [27,28], as shown in a study conducted in 2004 where the goal-directed therapy led to significantly increased fluid volumes in comparison to the Parkland formula [29]. Permissive hypovolemia has been studied afterwards and seems to have benefits regarding outcomes, without the associated adverse effects [30,31].…”

Section: Fluid Creepmentioning

confidence: 97%

An overview on fluid resuscitation and resuscitation endpoints in burns: Past, present and future. Part 1 — historical background, resuscitation fluid and adjunctive treatment

Peeters¹,

Vandervelden²,

Wise³

et al. 2015

Anaesthesiol Intensive Ther

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An improved understanding of burn shock pathophysiology and subsequent development of fluid resuscitation strategies has led to dramatic outcome improvements in burn care during the 20th century. While organ hypoperfusion caused by inadequate resuscitation has become rare in clinical practice, there is growing concern that increased morbidity and mortality related to over-resuscitation is occurring more frequently in burn care. In order to reduce complications related to this concept of "fluid creep", such as respiratory failure and compartment syndromes, efforts should be made to resuscitate with the least amount of fluid in order to provide adequate organ perfusion. In this first part of a concise review, historic and current evidence regarding the available fluids is discussed, as well as some adjunctive treatments modulating the inflammatory response. In the second part, special reference will be made to the role of abdominal hypertension in burn care and the endpoints used to guide fluid resuscitation will be discussed. Finally, as urine output has been recognized as a poor resuscitation target, a resuscitation protocol is suggested in part two which includes new targets and endpoints that can be obtained with modern, less invasive hemodynamic monitoring devices.

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“…Following published results from studies investigating haemodynamic orientated burn shock resuscitation monitoring techniques [14,23,24] and repeated local clinical audits a protocol of permissive hypovolaemic resuscitation was developed at SWCBC. We believe that children with partial thickness scalds of between 10-20% BSA, resuscitated at a lower rate of fluid administration than the Parkland formula suggests (table 1), especially if managed with biosynthetic dressings, may be less likely to develop complications attributable to over-resuscitation.…”

Section: Discussionmentioning

confidence: 99%

Lack of a standardised UK care pathway resulting in national variations in management and outcomes of paediatric small area scalds

Trevatt

Kirkham

Allix

et al. 2016

Burns

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. A reduced fluid regime has significantly shortened LOS/%BSA without compromising burn depth. A prospective randomised control trial comparing permissive hypovolaemia resuscitation to current recommended regimes for moderate paediatric scald injuries would help clarify.

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A clinical randomized study on the effects of invasive monitoring on burn shock resuscitation

Cited by 157 publications

References 23 publications

Incidence and prognosis of intra-abdominal hypertension and abdominal compartment syndrome in severely burned patients: Pilot study and review of the literature

Incidence and prognosis of intra-abdominal hypertension and abdominal compartment syndrome in severely burned patients: Pilot study and review of the literature

An overview on fluid resuscitation and resuscitation endpoints in burns: Past, present and future. Part 1 — historical background, resuscitation fluid and adjunctive treatment

Lack of a standardised UK care pathway resulting in national variations in management and outcomes of paediatric small area scalds

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