Burn resuscitation with two doses of 4 mL/kg hypertonic saline dextran provides sustained fluid sparing: a 48-hour prospective study in conscious sheep.
BACKGROUND
The large fluid volumes usually required for burn resuscitation can be suppressed for 8 to 12 hours by intravenous infusion of 4 mL x kg(-1) hypertonic saline dextran (HSD) 1 hour after burn. We hypothesized that a double (8 mL x kg(-1)) dose of HSD or two repeated doses of 4 mL x kg(-1) could enhance or prolong the volume sparing.


METHODS
We produced a full-thickness flame burn covering 40% of the body surface on 18 anesthetized sheep. One hour after the burn, the animals were awake and resuscitated with either (1) lactated Ringer's solution (LR) only, (2) 8 mL x kg(-1) HSD followed by LR, or (3) 4 mL x kg(-1) HSD followed by LR, with a second dose of 4 mL x kg(-1) HSD administered when net fluid accumulation increased to 20 mL x kg(-1). For all regimens, infusion rates were adjusted to produce a urine output of 1 to 2 mL x kg(-1) x h(-1).


RESULTS
Animals resuscitated with only LR required fluid volumes identical to that predicted by the Parkland formula for the first 12 hours. Infusion of 8 mL x kg(-1) HSD initially created a net fluid loss (urine output > infused volume), followed by a rebound fluid requirement eventually equaling that of animals treated with LR only. Animals treated with two separate doses of 4 mL x kg(-1) HSD generally did not experience a net fluid loss or a rebound fluid requirement. Also in the HSD x 2 group, peak and net fluid accumulation was less than that of the other two groups from 18 hours through 48 hours, although the difference was not significant.


CONCLUSIONS
An initial 4 mL x kg(-1) dose of HSD reduces fluid requirements early after burn, and a second dose administered after an appropriate interval may prolong volume sparing through 48 hours. An 8 mL x kg(-1) continuously infused initial dose was without prolonged fluid sparing effect. The volume-sparing effect of HSD is thus dependent on all of the following: dose, dosing interval, and infusion rate.
Elgjo
G I
GI
Department of Anesthesiology, University of Texas Medical Branch, Galveston, USA. gelgjo@utmb.edu
Traber
D L
DL
Hawkins
H K
HK
Kramer
G C
GC
D000818:Animals; D002056:Burns / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D003911:Dextrans / Q000008:administration & dosage*; D004195:Disease Models, Animal; D004334:Drug Administration Schedule; D004487:Edema / Q000517:prevention & control; D005260:Female; D018495:Fluid Shifts; D006439:Hemodynamics / Q000187:drug effects; D007262:Infusions, Intravenous; D011446:Prospective Studies; D015532:Rehydration Solutions / Q000008:administration & dosage*; D012151:Resuscitation; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage; D012756:Sheep; D012774:Shock, Traumatic / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors
D003911:Dextrans; D015532:Rehydration Solutions; D012462:Saline Solution, Hypertonic