Effect of Crystalloid Resuscitation and Inhalation Injury on Extravascular Lung Water

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

doi:10.1378/chest.121.6.1956

Cited by 71 publications

(24 citation statements)

References 28 publications

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“…More fluid must be given in the immediate period following thermal injury in patients with inhalation injury (208,369). Various agents have been administered, including inhaled heparin along with bronchodilators or free-radical scavenging agents such as dimethyl sulfoxide or N-acetylcysteine, in the treatment of inhalation injury in order to decrease cast formation and small-airway obstruction (15,61,229,275).…”

Section: Inhalation Injurymentioning

confidence: 99%

Burn Wound Infections

Church

Elsayed

Reid³

et al. 2006

Clin Microbiol Rev

1,595

1,345

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SUMMARYBurns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.

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Section: Inhalation Injurymentioning

confidence: 99%

Burn Wound Infections

Church

Elsayed

Reid³

et al. 2006

Clin Microbiol Rev

1,595

1,345

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show abstract

“…Resuscitation of burn shock cannot hope to achieve complete normalization of physiologic variables because the burn injury leads to ongoing cellular and hormonal responses. The obvious challenge is to provide enough fluid replacement to maintain perfusion without causing fluid overload (3,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

Section: Resuscitation Goalsmentioning

confidence: 99%

“…Most edema occurs locally at the burn site and is maximal at 24 hrs postinjury (5,14,17,18,25,33,34). The rate and extent of edema formation in major burn injury far exceed the intended beneficial effect of inflammatory system activation (21, 25).…”

Section: Burn Shock Pathophysiologymentioning

confidence: 99%

Critical care of the burn patient: The first 48 hours

Latenser

2009

Critical Care Medicine

185

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The critically burned patient differs from other critically ill patients in many ways, the most important being the necessity of a team approach to patient care. The burn patient is best cared for in a dedicated burn center where resuscitation and monitoring concentrate on the pathophysiology of burns, inhalation injury, and edema formation. Early operative intervention and wound closure, metabolic interventions, early enteral nutrition, and intensive glucose control have led to continued improvements in outcome. Prevention of complications such as hypothermia and compartment syndromes is part of burn critical care. The myriad areas where standards and guidelines are currently determined only by expert opinion will become driven by level 1 data only by continued research into the critical care of the burn patient.

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“…84 In contrast, other groups were unable to determine whether resuscitation aimed at normalizing BD was effective or beneficial, 6,85 and in two other trials, attaining target values of preload, CI, or VO 2 required more fluid-as much as four times Parkland predictions-without obvious improvements in survival. 86,87 In a trial involving 50 adult patients randomized to receive either strict Parkland or goal-directed resuscitation, Holm et al found no differences in mortality, intensive care unit or ventilator days, pH, or serum lactate levels. 88 Cardiac index was increased in the goal-directed group only at 24 hours post-burn, and all parameters were identical by 48 hours.…”

Section: The Influence Of Goal-directed Resuscitationmentioning

confidence: 99%

The Phenomenon of “Fluid Creep” in Acute Burn Resuscitation

Saffle

2007

Journal of Burn Care & Research

283

146

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Several reports have documented that modern burn patients receive far more resuscitation fluid than predicted by the Parkland formula-a phenomenon termed "fluid creep." This article reviews the incidence, consequences, and possible etiologies of fluid creep in modern practice and uses this information to propose some therapeutic strategies to reduce or eliminate excessive fluid resuscitation in burn care. A literature review was performed of historical references that form the foundation of modern fluid resuscitation, as well as reports of fluid creep and its consequences. The original Parkland formula required a 24-hour volume of 4 ml/kg/%TBSA lactated Ringer's solution followed by an infusion of 0.3-0.5 ml/kg/ %TBSA plasma. Modern iterations of this formula have omitted the colloid bolus. Numerous exceptions to the formula have been noted, most consistently patients with inhalation injuries. In contrast, recent reports document greatly increased fluid requirements in unselected patients, which seems to consist largely of progressive edema formation in unburned areas, increasing after the first 8 hours post-burn. This has been linked to occurrence of the abdominal compartment syndrome and other serious complications. Strategies to reduce fluid creep include the avoidance of early overresuscitation, use of colloid as a routine component of resuscitation or for "rescue," and adherence to protocols for fluid resuscitation. Fluid creep is a significant problem in modern burn care. Review of original investigations of burn shock, coupled with modern reports of fluid creep, suggests several mechanisms by which this problem can be controlled. Prospective trials of these therapies are needed to confirm their effectiveness.

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Effect of Crystalloid Resuscitation and Inhalation Injury on Extravascular Lung Water

Cited by 71 publications

References 28 publications

Burn Wound Infections

Burn Wound Infections

Critical care of the burn patient: The first 48 hours

The Phenomenon of “Fluid Creep” in Acute Burn Resuscitation

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