title: Hypertonic saline dextran produces early (8-12 hrs) fluid sparing in burn resuscitation: a 24-hr prospective, double-blind study in sheep.
abstract: OBJECTIVE
  Resuscitation of large burn injuries must quickly restore and maintain cardiovascular function and fluid balance while minimizing secondary edema-related damage. We tested the hypothesis that two 4-mL x kg(-1) doses of hypertonic saline dextran (HSD; 7.5% NaCl/6% dextran-70) can produce prolonged reduction in fluid requirements after burn injury.
  
  
  METHODS
  Prospective, pseudo randomized, double-blind study.
  
  
  METHODS
  Animal research laboratory.
  
  
  METHODS
  Female adult Merino sheep (n = 12).
  
  
  METHODS
  Sheep were given a 40% total body surface area full-thickness flame burn under halothane anesthesia. One hour after the burn, the conscious animals received an initial dose of 4 mL x kg(-1) HSD (n = 6) or normal saline (NS; NaCl 0.9%) (n = 6) intravenously during 30 mins. This was followed by lactated Ringer's solution, infused to a target urine output of 1 mL x kg(-1) x hr(-1) throughout the 24-hr study. A second 4-mL x kg(-1) dose of HSD or NS was started at 12 hrs, and infused during 5 hrs.
  
  
  RESULTS
  Hourly urine output measurements were used to guide the infusion rate of the lactated Ringer's. The initial infusion of HSD 1 hr after the burn injury promptly restored cardiac index, promoted diuresis, and reduced fluid requirements compared with the NS controls (73% reduction for HSD relative to NS at 8 hrs). Subsequent rebound fluid accumulation resulted in similar net fluid balances in both groups within 12 hrs after the burn. The second dose of HSD, given at 12 hrs, was without effect on hemodynamics and fluid balance.
  
  
  CONCLUSIONS
  We conclude a considerable initial, but not sustained fluid-sparing effect of early HSD, and no effect of a late, slowly infused HSD dose in this two-dose regimen.
authors.affiliation: Department of Anesthesiology, University of Texas Medical Branch, Galveston, USA.
authors.forename: G I
authors.initials: GI
authors.lastname: Elgjo
authors.forename: L F
authors.initials: LF
authors.lastname: Poli de Figueiredo
authors.forename: P J
authors.initials: PJ
authors.lastname: Schenarts
authors.forename: D L
authors.initials: DL
authors.lastname: Traber
authors.forename: L D
authors.initials: LD
authors.lastname: Traber
authors.forename: G C
authors.initials: GC
authors.lastname: Kramer
mesh_terms: D000818:Animals; D002056:Burns / Q000097:blood / Q000628:therapy* / Q000652:urine; D002940:Circadian Rhythm; D003911:Dextrans / Q000494:pharmacology*; D004311:Double-Blind Method; D004487:Edema / Q000378:metabolism; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D010952:Plasma Substitutes / Q000494:pharmacology*; D011446:Prospective Studies; D011897:Random Allocation; D015532:Rehydration Solutions / Q000494:pharmacology*; D012151:Resuscitation / Q000379:methods; D012462:Saline Solution, Hypertonic / Q000494:pharmacology*; D012756:Sheep; D012769:Shock / Q000097:blood / Q000628:therapy* / Q000652:urine; D014882:Water-Electrolyte Balance / Q000187:drug effects*
chemical_list: D003911:Dextrans; D010952:Plasma Substitutes; D015532:Rehydration Solutions; D012462:Saline Solution, Hypertonic