Haemodynamic and oxygen transport responses in survivors and non-survivors following thermal injury.
Resuscitation from shock based on invasive hemodynamic monitoring has been widely used in trauma and surgical patients, but has been only sparsely evaluated in thermally injured patients, probably due to fear of invasive monitoring in this group of patients. However, end-point resuscitation to fixed circulatory and oxygen transport values has been proposed to be associated with an improved survival rate following trauma and high-risk surgery. Furthermore, the early circulatory response to resuscitation has been shown to be predictive of survival in these patients. In this study the early hemodynamic and oxygen transport profile following thermal injury was analysed with the aim to detect possible differences in the response of survivors and non-survivors. The transpulmonary thermodilution technique was used for hemodynamic monitoring of 21 patients, who were admitted to our burn unit with severe burns. Six patients died and 15 patients survived to leave the intensive care unit. Survivors were found to have a significantly higher cardiac index and oxygen delivery rate during the early postburn period than non-survivors. Furthermore, initial serum lactate levels as well as the ability to clear elevated lactate were found to be significantly associated with survival. Blood pressure and heart rate were not significantly different between the two groups of patients. All patients received significantly higher volumes of crystalloids during the first 24 h than predicted from the Baxter formula, independent of outcome. We concluded that standard vital signs such as blood pressure and heart rate may be invalid as outcome related resuscitation goals, and too insensitive to ensure appropriate fluid replacement. The response to fluid therapy may be significantly associated with outcome; survivors responding with an augmentation of cardiac output and oxygen delivery not seen in non-survivors. Lactate levels seem to correlate with organ failure and death and appear a suitable end-point for resuscitation of severely burned patients.
Holm
C
C
Department of Plastic Surgery/Burn Center, Klinikum Bogenhausen, Technical University Munich, Academic Teaching Hospital, Germany.
Melcer
B
B
Hörbrand
F
F
Wörl
H H
HH
von Donnersmarck
G H
GH
Mühlbauer
W
W
D000328:Adult; D000368:Aged; D001692:Biological Transport; D001794:Blood Pressure / Q000502:physiology; D002053:Burn Units; D002056:Burns / Q000401:mortality* / Q000503:physiopathology; D002302:Cardiac Output / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007773:Lactates / Q000097:blood; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods; D015996:Survival Rate; D013815:Thermodilution
D007773:Lactates; D010100:Oxygen