Fluid replacement in burned patients.

Bortolani A, Governa M, Barisoni D. 1st Division of Plastic and Reconstructive Surgery, Ospedale Civile MaggioreVerona, Italy. urn in!ury involves a large a"ount of #ater, electrolytes and proteins loss troug$ t$e %urn #ound. &or t$is reason, to avoid s$oc', a #ide infusion of fluid is necessary in t$e first $ours after trau"a. Many reani"ation for"ulas #ere proposed in t$e past years, #it$ different co"position( saline, colloids, plas"a. )$e aut$ors $ave studied *+ %urned patients ad"itted in Verona urn Center #it$in * $ours after %urn, #it$ %urns over ,+- of t$e %ody surface area. )#enty of t$e" #ere treated #it$ a.ter reani"ation for"ula /ringer lactated saline, R0S1 #$ile t$e ot$ers #it$ Monafo $ypertonic lactated saline /20S1, "odified %y Milan urn Center. )$e t#o rando"i3ed groups #ere assessed and co"pared. In R0S group total fluid volu"e infused #as $ig$er #$ile sodiu" re4uire"ents #as lo#er t$an in 20S patients, #it$ statistically significative difference /p 5 +.+11. On t$e contrary, in 20S group, potassiu" ad"inistered #as per$aps t#ice if co"pared #it$ t$e ot$er. 2ae"atocrit, urine output and urine os"olarity #ere ade4uate in %ot$ t$e groups, and did not s$o#ed statistical differences, suc$ as seru" proteins concentration, t$at #as lo# in all patients, #$ile a significative difference #as noted in urine os"olarity /p 5 +.+11. 6 "eta%olic al'alosis #as present in 20S patients, #$ile, on t$e ot$er $and, seru" nitrogen #as significantly $ig$er /p 5 +.+71, in t$e first *8 $ours after %urn, in R0S group. Patients #ere assessed for pre-e.isting diseases too, and data s$o#ed t$at co"plications #ere lo#er in 20S t$an in R0S group. 20S resuscitation for"ula guarantees a good electrolytes %alance #it$ lo#er fluid load, reducing tissue oede"a and co"plication rate. Mortality rate #as $ig$er in 20S, "ay %e for an $ig$er Roy inde. in t$is group. Pu%lication )ypes( Clinical )rial Rando"i3ed Controlled )rial PMID( 9+,::9+ ;Pu%Med - inde.ed for M<D0I=<>

Clinical study of a formula for delayed rapid fluid resuscitation for patients with burn shock.
uan! ", "an B, "an! #. Institute of urn Researc$, Sout$#est 2ospital, State ?ey 0a%oratory of )rau"a, urns

and Co"%ined In!ury, )$ird Military Medical @niversity, C$ong4ing *+++,8, C$ina. O A<C)IV<(( )o e.plore a suita%le for"ula of delayed rapid fluid resuscitation for patients #it$ %urn s$oc'. M<)2ODS(( )#enty patients #it$ %urns over *+- of total %ody surface area /) S61 ad"itted *-8$ after in!ury #ere studied. Plas"a #as used as colloid in 9 cases in t$e infused patients /t$e plas"a group, PB1 and gelofusine #as used as colloid in 11 cases in t$e infused patients /t$e gelofusine group, BB1. Rapid fluid resuscitation #as ad"inistered under strict $e"odyna"ic "onitoring i""ediately after ad"ission. 2e"odyna"ic inde.es including pul"onary arterial pressure /P6P1, pul"onary artery #edge pressure /P6CP1, cardiac output /CO1, pul"onary vascular resistance /PVR1, and syste"ic vascular resistance /SVR1, $e"or$eological para"eters suc$ as %lood viscosity and plas"a viscosity, and tissue o.ygenation indices o.ygen delivery /DO/D11, o.ygen consu"ption /VO/D11, o.ygen e.traction /O/D1e.t1, lactic acid /061 and %ase deficiency of arterial %lood /6D1 #ere deter"ined in order to "onitor function in or da"age to i"portant viscera. R<S@0)S(( )$e a"ount of fluid rapidly infused in t$e first D$ after $ospitali3ation accounted for ,8.8EF-G.+- of t$e re4uired fluid a"ount for t$e first D*$ as calculated fro" t$e for"ula. C$en t$e a"ount of fluid infused into t$e patient %efore ad"ission to our $ospital #as added, t$e total a"ount accounted for *8.,EF-7.+- of t$e fluid a"ount for t$e first D*$. )$e actual a"ount of fluid infused in t$e first D*$ #as ,1.*EF-8.9- "ore t$an t$at of t$e a"ount calculated #it$ t$e <vansH for"ula. )$e a"ount of fluid infused in t$e second D*$ #as nearly e4ual to t$e a"ount calculated #it$ t$e <vansH for"ula. 6fter fast fluid replace"ent t$erapy, all t$e para"eters deter"ined #ere "ar'edly i"proved. CO=C0@SIO=(( It is suggested on t$e %asis of our study t$at t$e fluid a"ount for delayed rapid fluid resuscitation in patients #it$ %urn s$oc' s$ould %e calculated as follo#s( /11 in t$e first D*$, t$e a"ount of fluid /"l1 is e4ual to ) S6 /-1.%ody #eig$t /'g1.D.G. )$e ratio %et#een colloid and electrolytes is 1(1, eac$ of t$e t#o fluid types is 1.,"l per /-1 ) S6 per 'g %ody #eig$t. )$e volu"e of #ater re4uired is D+++"l. 2alf of t$e total a"ount of fluid is proposed s$ould %e infused in t$e first D$ after $ospitali3ation under strict "onitoring of $e"odyna"ic indices. /D1 In t$e second D*$, t$e a"ount of fluid /"l1 is e4ual to ) S6 /-1.%ody #eig$t /'g1.1. )$e ratio %et#een colloid and electrolytes 1(1, eac$ of t$e t#o is +.7"l. Cater volu"e is D+++"l. PMID( 1797,G81 ;Pu%Med - as supplied %y pu%lis$er>

Fluid replacement in burned patients.

Bortolani A, Governa M, Barisoni D. 1st Division of Plastic and Reconstructive Surgery, Ospedale Civile MaggioreVerona, Italy. urn in!ury involves a large a"ount of #ater, electrolytes and proteins loss troug$

t$e %urn #ound. &or t$is reason, to avoid s$oc', a #ide infusion of fluid is necessary in t$e first $ours after trau"a. Many reani"ation for"ulas #ere proposed in t$e past years, #it$ different co"position( saline, colloids, plas"a. )$e aut$ors $ave studied *+ %urned patients ad"itted in Verona urn Center #it$in * $ours after %urn, #it$ %urns over ,+- of t$e %ody surface area. )#enty of t$e" #ere treated #it$ a.ter reani"ation for"ula /ringer lactated saline, R0S1 #$ile t$e ot$ers #it$ Monafo $ypertonic lactated saline /20S1, "odified %y Milan urn Center. )$e t#o rando"i3ed groups #ere assessed and co"pared. In R0S group total fluid volu"e infused #as $ig$er #$ile sodiu" re4uire"ents #as lo#er t$an in 20S patients, #it$ statistically significative difference /p 5 +.+11. On t$e contrary, in 20S group, potassiu" ad"inistered #as per$aps t#ice if co"pared #it$ t$e ot$er. 2ae"atocrit, urine output and urine os"olarity #ere ade4uate in %ot$ t$e groups, and did not s$o#ed statistical differences, suc$ as seru" proteins concentration, t$at #as lo# in all patients, #$ile a significative difference #as noted in urine os"olarity /p 5 +.+11. 6 "eta%olic al'alosis #as present in 20S patients, #$ile, on t$e ot$er $and, seru" nitrogen #as significantly $ig$er /p 5 +.+71, in t$e first *8 $ours after %urn, in R0S group. Patients #ere assessed for pre-e.isting diseases too, and data s$o#ed t$at co"plications #ere lo#er in 20S t$an in R0S group. 20S resuscitation for"ula guarantees a good electrolytes %alance #it$ lo#er fluid load, reducing tissue oede"a and co"plication rate. Mortality rate #as $ig$er in 20S, "ay %e for an $ig$er Roy inde. in t$is group. Pu%lication )ypes( Clinical )rial Rando"i3ed Controlled )rial PMID( 9+,::9+ ;Pu%Med - inde.ed for M<D0I=<>

Chemical burns$ our %&'year e(perience.

)in!er A, )a!i A, Ben Meir *, +osenber! ,. Depart"ent of Reconstruction and Plastic Surgery, Soro'a Medical Center, &aculty of 2ealt$ Sciences, en-Burion @niversity of t$e =egev, eer-S$eva. 6 revie# of 1:, patients #it$ c$e"ical %urns ad"itted to our %urn unit #as carried out during t$e years 19:G-87. Most %urns #ere #or' related /8, per cent1. )$e "a!ority of patients #ere "en aged D1-7+ years /"ean age I D9.G years1. )$e "ean total %ody surface area involved #as ,.G per cent /range I 1-,+ per cent1. )$e "ean lengt$ of stay in $ospital #as G., days /range I 1-7D days1. )$e e.tre"ities #ere involved in G8 per cent of t$e patients. )$e "ore co""on aetiological agents #ere %ro"ine and its co"pounds /,G per cent1, t$en acids /D1 per cent1, al'alis and organic su%stances /1*.7 per cent

eac$1. )$e severest %urns #ere caused %y t$e inorganic su%stances. Delayed ad"ission #as "ost c$aracteristic of t$e %ro"ine and al'ali %urns. Co"plications included local infection /19 cases1, syste"ic infection /t#o cases1, in$alation in!ury /t#o cases1, tissue necrosis /one case1 and corneal erosion /one case1. )$ere #ere no deat$s. Increased a#areness of t$e $a3ardous potential of c$e"icals s$ould $elp reduce t$e incidence of c$e"ical %urns. PMID( 1G*D::: ;Pu%Med - inde.ed for M<D0I=<>ssss