Hemodynamic Changes During Resuscitation After Burns Using the Parkland Formula

Bak, Zoltán; Sjöberg, Folke; Eriksson, Olle; Steinvall, Ingrid; Janerot-Sjöberg, Birgitta

doi:10.1097/ta.0b013e318165c822

Cited by 42 publications

(19 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Instead, this was not observed in the permissive hypovolemia group in Arlati et al . 's study [15] or in a study by Bak [10]. We found normal initial levels of EVLW and a progressive increase during the first 40 hours of resuscitation.…”

Section: Discussionsupporting

confidence: 54%

A protocol for resuscitation of severe burn patients guided by transpulmonary thermodilution and lactate levels: a 3-year prospective cohort study

et al. 2013

View full text Add to dashboard Cite

IntroductionThe use of urinary output and vital signs to guide initial burn resuscitation may lead to suboptimal resuscitation. Invasive hemodynamic monitoring may result in over-resuscitation. This study aimed to evaluate the results of a goal-directed burn resuscitation protocol that used standard measures of mean arterial pressure (MAP) and urine output, plus transpulmonary thermodilution (TPTD) and lactate levels to adjust fluid therapy to achieve a minimum level of preload to allow for sufficient vital organ perfusion.MethodsWe conducted a three-year prospective cohort study of 132 consecutive critically burned patients. These patients underwent resuscitation guided by MAP (>65 mmHg), urinary output (0.5 to 1 ml/kg), TPTD and lactate levels. Fluid therapy was adjusted to achieve a cardiac index (CI) >2.5 L/minute/m2 and an intrathoracic blood volume index (ITBVI) >600 ml/m2, and to optimize lactate levels. Statistical analysis was performed using mixed models. We also used Pearson or Spearman methods and the Mann-Whitney U-test.ResultsA total of 98 men and 34 women (mean age, 48 ± 18 years) was studied. The mean total body surface area (TBSA) burned was 35% ± 22%. During the early resuscitation phase, lactate levels were elevated (2.58 ± 2.05 mmol/L) and TPTD showed initial hypovolemia by the CI (2.68 ± 1.06 L/minute/m2) and the ITBVI (709 ± 254 mL/m2). At 24 to 32 hours, the CI and lactic levels were normalized, although the ITBVI remained below the normal range (744 ± 276 ml/m2). The mean fluid rate required to achieve protocol targets in the first 8 hours was 4.05 ml/kg/TBSA burned, which slightly increased in the next 16 hours. Patients with a urine output greater than or less than 0.5 ml/kg/hour did not show differences in heart rate, mean arterial pressure, CI, ITBVI or lactate levels.ConclusionsInitial hypovolemia may be detected by TPTD monitoring during the early resuscitation phase. This hypovolemia might not be reflected by blood pressure and hourly urine output. An adequate CI and tissue perfusion can be achieved with below-normal levels of preload. Early resuscitation guided by lactate levels and below-normal preload volume targets appears safe and avoids unnecessary fluid input.

show abstract

Section: Discussionsupporting

confidence: 54%

A protocol for resuscitation of severe burn patients guided by transpulmonary thermodilution and lactate levels: a 3-year prospective cohort study

et al. 2013

View full text Add to dashboard Cite

show abstract

“…(J Burn Care Res 2016;37:e287-e291) during the first hour of admission; central access was obtained, and the patient's trachea was intubated. Crystalloid (Plasmalyte © , Baxter International, Deerfield, IL) was administered using the Parkland fluid resuscitation strategy 11 to achieve a urine output of 1 ml/kg/hr: 4 ml/kg × body weight (kg) × %TBSA = total fluid volume (ml); 50% given during the first 8 hours, with the remainder given during the following 16 hours. 11 A bronchoscopic exam was consistent with grade I (one) inhalation injury; his carboxyhemoglobin level was 8%.…”

Section: Case Reportmentioning

confidence: 99%

“…Crystalloid (Plasmalyte © , Baxter International, Deerfield, IL) was administered using the Parkland fluid resuscitation strategy 11 to achieve a urine output of 1 ml/kg/hr: 4 ml/kg × body weight (kg) × %TBSA = total fluid volume (ml); 50% given during the first 8 hours, with the remainder given during the following 16 hours. 11 A bronchoscopic exam was consistent with grade I (one) inhalation injury; his carboxyhemoglobin level was 8%. A cardiologist performed a baseline transthoracic echocardiogram (TTE), which yielded grade I diastolic dysfunction, ejection fraction of 55%, and no valvular pathology.…”

Section: Case Reportmentioning

confidence: 99%

Methylene Blue for Acute Septic Cardiomyopathy in a Burned Patient

Schlesinger

Burger

2016

Journal of Burn Care & Research

View full text Add to dashboard Cite

The objective of this case summary was to describe the use of methylene blue (MB) in a burned patient with acute septic cardiomyopathy. A 60-year-old Caucasian man was admitted to the Burn Intensive Care Unit with 45% TBSA burns after a house explosion. During the course of his care, he experienced hypotension that was refractory to fluid therapy and vasoactive medications. Echocardiography and right heart catheterization showed new acute systolic dysfunction with concurrent elevated systemic vascular resistance (SVR). High-dose inotropic agents did not improve cardiac function, and septic shock rendered him a poor candidate for mechanical intra-aortic balloon pump support. MB was administered to sensitize the myocardium to catecholamines and improve contractility with the goal of weaning the other vasoactive medications and diuresing for afterload reduction when hemodynamic stability was achieved. MB has been described in critical care medicine predominately for vasoplegia after cardiopulmonary bypass and vasodilatory septic shock., Our patient had acute septic cardiomyopathy that was refractory to standard pharmacologic approaches to inotropy with concurrent elevated SVR. Hypothesizing the differential temporal effect of inducible nitric oxide synthase on the vasculature and myocardium, we administered MB to improve contractility and support the impending vasodilatory effects of distributive shock. Although MB is not a new drug, the application for septic cardiomyopathy with a supranormal SVR is a unique application. Because of the risk profile associated with MB, we recommend drug monitoring utilizing serial echocardiography and/or right heart catheterization.

show abstract

“…Although this may be true for some patients, when IAH and ACS develop, oliguria may no longer be related to fluid depletion, and increasing resuscitation volumes may further worsen the problem of IAH [22].…”

Section: Prevention and Diagnosis Of Iah And Acs In Burn Patientsmentioning

confidence: 99%

Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine

Malbrain¹,

Keulenaer²,

Oda³

et al. 2015

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

Intra-abdominal hypertension (IAH) is an important contributor to early organ dysfunction in trauma and sepsis. However, relatively little is known about the impact of intra-abdominal pressure (IAP) in general internal medicine, pregnant patients, and those with obesity or burns. The aim of this paper is to review the pathophysiologic implications and treatment options for IAH in these specific situations. A MEDLINE and PubMed search was performed and the resulting body-of-evidence included in the current review on the basis of relevance and scientific merit. There is increasing awareness of the role of IAH in different clinical situations. Specifically, IAH will develop in most (if not all) severely burned patients, and may contribute to early mortality. One should avoid over-resuscitation of these patients with large volumes of fluids, especially crystalloids. Acute elevations in IAP have similar effects in obese patients compared to non-obese patients, but the threshold IAP associated with organ dysfunction may be higher. Chronic elevations in IAP may, in part, be responsible for the pathogenesis of obesity-related co-morbid conditions such as hypertension, pseudotumor cerebri, pulmonary dysfunction, gastroesophageal reflux disease, and abdominal wall hernias. At the bedside, measuring IAP and considering IAH in all critical maternal conditions is essential, especially in preeclampsia/eclampsia where some have hypothesized that IAH may have an additional role. IAH in pregnancy must take into account the precautions for aorto-caval compression and has been associated with ovarian hyperstimulation syndrome. Recently, IAP has been associated with the cardiorenal dilemma and hepatorenal syndrome, and this has led to the recognition of the polycompartment syndrome. In conclusion, IAH and ACS have been associated with several patient populations beyond the classical ICU, surgical, and trauma patients. In all at risk conditions the focus should be on the early recognition of IAH and prevention of ACS. Patients at risk for IAH should be identified early through measurements of IAP. Appropriate actions should be taken when IAP increases above 15 mm Hg, especially if pressures reach above 20 mm Hg with new onset organ failure. Although non-operative measures come first, surgical decompression must not be delayed if these fail. Percutaneous drainage of ascites is a simple and potentially effective tool to reduce IAP if organ dysfunction develops, especially in burn patients. Escharotomy may also dramatically reduce IAP in the case of abdominal burns.

show abstract

Hemodynamic Changes During Resuscitation After Burns Using the Parkland Formula

Cited by 42 publications

References 51 publications

A protocol for resuscitation of severe burn patients guided by transpulmonary thermodilution and lactate levels: a 3-year prospective cohort study

A protocol for resuscitation of severe burn patients guided by transpulmonary thermodilution and lactate levels: a 3-year prospective cohort study

Methylene Blue for Acute Septic Cardiomyopathy in a Burned Patient

Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine

Contact Info

Product

Resources

About