A prospective, randomized evaluation of intra-abdominal pressures with crystalloid and colloid resuscitation in burn patients.
BACKGROUND
The volume of resuscitation in burn patients has been shown to correlate with intra-abdominal pressure (IAP). Limiting volume may reduce consequences of IAP and abdominal compartment syndrome. Colloid resuscitation has been previously shown to limit the volume required initially after burn.


METHODS
Thirty-one patients were prospectively followed. Inclusion criteria were a burn of 25% total body surface area with inhalation injury or 40% total body surface area without. Patients received crystalloid (Parkland formula) or plasma resuscitation. IAP was measured by means of urinary bladder transduction.


RESULTS
Mean age, area of burn, and baseline IAP were not different. Urine output was maintained. There was a greater increase in IAP with crystalloid (26.5 vs. 10.6 mmHg, p < 0.0001). Two patients in the plasma group developed IAP greater than 25 mmHg; only one patient in the crystalloid group maintained IAP less than 25 mmHg. More fluid volume was required with crystalloid resuscitation, 0.26 L/kg, versus 0.21 L/kg (p < 0.005). Correlation was seen in both groups between volume of fluid and IAP (crystalloid, r = 0.351; plasma, r = 0.657; all patients, r = 0.621).


CONCLUSIONS
Plasma-resuscitated patients maintained an IAP below the threshold of complications of intra-abdominal hypertension. This appears to be a direct result of the decrease in volume required. Lower fluid volume regimens should be given consideration as the incidence and consequences of intra-abdominal hypertension in burn patients continue to be defined.
O'Mara
Michael S
MS
Department of Burns Surgery, Shriner's Hospital for Children of Northern California, USA.
Slater
Harvey
H
Goldfarb
I William
IW
Caushaj
Philip F
PF
D000005:Abdomen / Q000503:physiopathology*; D000328:Adult; D001830:Body Surface Area; D002056:Burns / Q000503:physiopathology* / Q000628:therapy*; D003102:Colloids / Q000627:therapeutic use; D000077324:Crystalloid Solutions; D006801:Humans; D007552:Isotonic Solutions; D008875:Middle Aged; D010949:Plasma; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011312:Pressure; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome
D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes