Impact of a bicarbonated saline solution on early resuscitation after major burns

• Published in: Intensive care medicine 2000-09, Vol.26 (9), p.1382-1385
• Main Authors: BERGER, Mette M, PICTET, Anne, REVELLY, Jean-Pierre, FRASCAROLO, Philippe, CHIOLERO, René L
• Format: Article
• Language: English
• Subjects: Acidosis; Adult; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Burns; Burns - therapy; Chi-Square Distribution; Chloride; Creatinine; Critical Care - methods; Edema; Emergency and intensive care: burns; Female; Fluid Therapy - methods; Hemodynamics; Humans; Hydroxyethyl Starch Derivatives - therapeutic use; Intensive care medicine; Isotonic Solutions - therapeutic use; Leukocytes; Male; Medical sciences; Patients; Plasma; Plasma Substitutes - therapeutic use; Resuscitation - methods; Retrospective Studies; Ringer's Solution; Saline Solution, Hypertonic - therapeutic use; Sodium; Sodium Bicarbonate - therapeutic use; Treatment Outcome; Ventilators
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s001340000615

The study aimed at assessing the impact of the introduction of a bicarbonated saline solution on total fluid load, weight gain and acid base status during acute burn resuscitation. Based on a retrospective patient record review. Burn care centre of a surgical ICU in a tertiary university hospital. Two groups of adult patients (20/20), with thermal burns of 25% or more body surface area were studied. Modification of the resuscitation fluid composition from lactated Ringer's solution (LR: Na 132 mmol/l, Cl 112 mmol/l, 263 mosm/l), to bicarbonated 0.9% saline (BS: Na 180 mmol/l, Cl 154 mmol/l, 340 mosm/l) Age, weight, burn size and depth, inhalation injury, fluid intakes over 48 h post-injury, plasma sodium, chloride, creatinine, albumin levels, blood gases and ventilation support were recorded. The demographic characteristics of the patients (41 +/- 16 years) in the two groups were not different, with severe burns involving 44 +/- 17% body surface area. While the total fluid volumes administered did not differ, BS was associated with lower plasma pH, base excess and bicarbonate levels for 24 h and with hyperchloraemia. Clinical evolution did not differ. Using bicarbonated saline solution for resuscitation causes a transient hyperchloraemic dilutional acidosis compared with LR, and has no other detectable clinical impact over the first 10 days after severe burn injury.