Decreased fluid volume to reduce organ damage: A new approach to burn shock resuscitation? A preliminary study

• Published in: Resuscitation 2007-03, Vol.72 (3), p.371-378
• Main Authors: Arlati, S, Storti, E, Pradella, V, Bucci, L, Vitolo, A, Pulici, M
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Body Fluids - metabolism; Burn injury; Burn Units; Burns - complications; Burns - metabolism; Burns - therapy; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency and intensive respiratory care; Female; Fluid therapy; Fluid Therapy - methods; Follow-Up Studies; Haemodynamics; Humans; Hypovolemia - metabolism; Intensive care medicine; Lactates - blood; Male; Medical sciences; Middle Aged; Resuscitation; Resuscitation - methods; Retrospective Studies; Shock; Shock, Traumatic - etiology; Shock, Traumatic - metabolism; Shock, Traumatic - therapy; Trauma Severity Indices; Treatment Outcome; Vascular Resistance - physiology
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2006.07.010

Summary Objective To evaluate the impact of decreased fluid resuscitation on multiple-organ dysfunction after severe burns. This approach was referred to as “permissive hypovolaemia”. Methods Two cohorts of patients with burns >20% BSA without associated injuries and admitted to ICU within 6 h from the thermal injury were compared. Patients were matched for both age and burn severity. The multiple-organ dysfunction score (MODS) by Marshall was calculated for 10 days after ICU admission. Permissive hypovolaemia was administered by a haemodynamic-oriented approach throughout the first 24-h period. Haemodynamic variables, arterial blood lactates and net fluid balance were obtained throughout the first 48 h. Results Twenty-four patients were enrolled: twelve of them received the Parkland Formula while twelve were resuscitated according to the permissive hypovolaemic approach. Permissive hypovolaemia allowed for less volume infusion (3.2 ± 0.7 ml/kg/% burn versus 4.6 ± 0.3 ml/kg/% burn; P < 0.001), a reduced positive fluid balance (+7.5 ± 5.4 l/day versus +12 ± 4.7 l/day; P < 0.05) and significantly lesser MODS Score values ( P = 0.003) than the Parkland Formula. Both haemodynamic variables and arterial blood lactate levels were comparable between the patient cohorts throughout the resuscitation period. Conclusions Permissive hypovolaemia seems safe and well tolerated by burn patients. Moreover, it seems effective in reducing multiple-organ dysfunction as induced by oedema fluid accumulation and inadequate O2 tissue utilization.