Safety of resuscitation with Ringer's acetate solution in severe burn (VolTRAB)—An observational trial

Gille, Jochen; Klezcewski, Birgit; Malcharek, Michael J.; Raff, Thomas; Mogk, Martin; Sablotzki, Armin; Taha, Hischam

doi:10.1016/j.burns.2013.11.021

Cited by 30 publications

(26 citation statements)

References 25 publications

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“…Gille et al compared RL with Ringer's acetate and found Ringer's acetate to be superior in terms of lower organ failure assessment scores, requirement of smaller amount of colloids, packed cells and plasma infusion, shorter duration of hospital stay and mechanical ventilation. However, there was no difference in the volume of crystalloid infused and the mortality [23].…”

Section: Determining the Initial Amount Of Fluid Therapymentioning

confidence: 85%

Critical care management in burns: A review of current evidence and guidelines -Part 1

2020

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Recent literature on the management of critically ill patients have altered the beliefs and clinical behaviours, questioning many dogmas that were practiced without much evidence. The critical care in a severely burn-injured patient requires special attention in resuscitation, haemodynamic monitoring, management of complications, organ support and determinants of outcome. The goal of resuscitation is to maintain intravascular volume and tone while correcting the reversible changes in altered physiology, aided by early debridement of burned tissue and elimination of the source of physiological derangement. Practitioners should target resuscitation based on goal-directed therapy using noninvasive markers of cardiac output. The management requires the input of a multidisciplinary team to achieve critical care and early surgical intervention and management of complications and organ support. Methods We performed a literature search on PubMed and Google Scholar, and looked for published original articles, review articles and guidelines on critical care management in burns, up to November 2019. Our search was limited to articles in English. Correspondence, dissertations and unpublished materials were not considered. The information were summarised and presented qualitatively (narratively) under subheadings. Contents: Fluid resuscitation in severe burns Goal-directed fluid therapy and Haemodynamic monitoring Evidence on choice of fluid for resuscitation Management of coagulopathy in severe burns Thromboprophylaxis in burns The role of suppressing hypermetabolism in severe burns Glycaemic control in severe burns Nutritional support in severe burns Sepsis and infection control in burns Management of inhalational injuries and acute respiratory distress syndrome (ARDS) Early surgical debridement and soft tissue cover Pain management in severe burns Palliative care in severe burns

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Section: Determining the Initial Amount Of Fluid Therapymentioning

confidence: 85%

Critical care management in burns: A review of current evidence and guidelines -Part 1

2020

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“…There are unfortunately no sufficiently large randomized controlled trials to determine the best choice for an isotonic crystalloid resuscitation fluid. One observational study reported lower Sequential Organ Failure Assessment scores in severely burned patients resuscitated with Ringer's acetate, however, this is an isolated study [41].…”

Section: Crystalloidsmentioning

confidence: 87%

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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“…Lactate can be utilized by multiple pathways and is unlikely to produce acute changes in acid-base balance [37]. In contrast, acetate-buffered solutions may produce metabolic alkalosis due to rapid production of bicarbonate from acetate [13, 15, 38, 39].…”

Section: Discussionmentioning

confidence: 99%

Fluid management in patients undergoing cardiac surgery: effects of an acetate- versus lactate-buffered balanced infusion solution on hemodynamic stability (HEMACETAT)

et al. 2019

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Background Recent evidence suggests that acetate-buffered infusions result in better hemodynamic stabilization than 0.9% saline in patients undergoing major surgery. The choice of buffer in balanced crystalloid solutions may modify their hemodynamic effects. We therefore compared the inopressor requirements of Ringer’s acetate and lactate for perioperative fluid management in patients undergoing cardiac surgery. Methods Using a randomized controlled double-blind design, we compared Ringer’s acetate (RA) to Ringer’s lactate (RL) with respect to the average rate of inopressor administered until postoperative hemodynamic stabilization was achieved. Secondary outcomes were the cumulative dose of inopressors, the duration of inopressor administration, the total fluid volume administered, and the changes in acid-base homeostasis. Patients undergoing elective valvular cardiac surgery were included. Patients with severe cardiac, renal, or liver disease were excluded from the study. Results Seventy-five patients were randomly allocated to the RA arm, 73 to the RL. The hemodynamic profiles were comparable between the groups. The groups did not differ with respect to the average rate of inopressors (RA 2.1 mcg/kg/h, IQR 0.5–8.1 vs. RL 1.7 mcg/kg/h, IQR 0.7–8.2, p = 0.989). Cumulative doses of inopressors and time on individual and combined inopressors did not differ between the groups. No differences were found in acid-base parameters and their evolution over time. Conclusion In this study, hemodynamic profiles of patients receiving Ringer’s lactate and Ringer’s acetate were comparable, and the evolution of acid-base parameters was similar. These study findings should be evaluated in larger, multi-center studies. Trial registration Clinicaltrials.gov NCT02895659 . Registered 16 September 2016. Electronic supplementary material The online version of this article (10.1186/s13054-019-2423-8) contains supplementary material, which is available to authorized users.

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Safety of resuscitation with Ringer's acetate solution in severe burn (VolTRAB)—An observational trial

Cited by 30 publications

References 25 publications

Critical care management in burns: A review of current evidence and guidelines -Part 1

Critical care management in burns: A review of current evidence and guidelines -Part 1

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

Fluid management in patients undergoing cardiac surgery: effects of an acetate- versus lactate-buffered balanced infusion solution on hemodynamic stability (HEMACETAT)

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