[Is albumin administration useful in critical care for burnt patients?].
The most typical reaction of the organism after a major burn consists in transcapillary shift from plasma into interstitial space. Capillary hyperpermeability, but also changes in colloid osmotic gradient and decrease in interstitial hydrostatic pressure, explain the fluid shift to burned and, at minor importance, non burned areas during the first post-burn day. The extent of capillary hyperpermeability results in inefficiency of colloid infusions in reducing fluid shift to burned areas. Some groups advocate colloid supply from the eighth post-burn hour, on when hyperpermeability decreases, in non burned sites. However, for most groups, restoration of a functional interstitial space has priority during the 24 first post-burn hours, justifying crystalloid supply without colloids. Furthermore, colloid infusion could be responsible for delayed pulmonary oedema, in the first days following initial fluid replacement. After 24 post-burn hours, in patients experiencing severe albumin depletion, infusion of human albumin is justified, in order to favour oedema resorption.
Manelli
J C
JC
Département d'anesthésie-réanimation et centre régional des Grands Brûlés, hôpital de la Conception, Marseille, France.
D000418:Albumins / Q000008:administration & dosage* / Q000494:pharmacology; D001825:Body Fluid Compartments / Q000502:physiology; D002056:Burns / Q000503:physiopathology / Q000628:therapy*; D003102:Colloids; D005110:Extracellular Space / Q000378:metabolism; D006801:Humans; D018836:Inflammation Mediators / Q000502:physiology; D008208:Lymphatic System / Q000502:physiology; D009997:Osmotic Pressure; D010952:Plasma Substitutes / Q000008:administration & dosage; D010953:Plasma Volume / Q000187:drug effects*
D000418:Albumins; D003102:Colloids; D018836:Inflammation Mediators; D010952:Plasma Substitutes