Clinical study of a formula for delayed rapid fluid resuscitation for patients with burn shock.
OBJECTIVE
To explore a suitable formula of delayed rapid fluid resuscitation for patients with burn shock.


METHODS
Twenty patients with burns over 40% of total body surface area (TBSA) admitted 4-8 h after injury were studied. Plasma was used as colloid in 9 cases in the infused patients (the plasma group, PG) and gelofusine was used as colloid in 11 cases in the infused patients (the gelofusine group, GG). Rapid fluid resuscitation was administered under strict hemodynamic monitoring immediately after admission. Hemodynamic indexes including pulmonary arterial pressure (PAP), pulmonary artery wedge pressure (PAWP), cardiac output (CO), pulmonary vascular resistance (PVR), and systemic vascular resistance (SVR), hemorheological parameters such as blood viscosity and plasma viscosity, and tissue oxygenation indices oxygen delivery (DO2), oxygen consumption (VO2), oxygen extraction (O2ext), lactic acid (LA) and base deficiency of arterial blood (AD) were determined in order to monitor function in or damage to important viscera.


RESULTS
The amount of fluid rapidly infused in the first 2 h after hospitalization accounted for 38.8+/-6.0% of the required fluid amount for the first 24 h as calculated from the formula. When the amount of fluid infused into the patient before admission to our hospital was added, the total amount accounted for 48.3+/-5.0% of the fluid amount for the first 24 h. The actual amount of fluid infused in the first 24 h was 31.4+/-8.9% more than that of the amount calculated with the Evans' formula. The amount of fluid infused in the second 24 h was nearly equal to the amount calculated with the Evans' formula. After fast fluid replacement therapy, all the parameters determined were markedly improved.


CONCLUSIONS
It is suggested on the basis of our study that the fluid amount for delayed rapid fluid resuscitation in patients with burn shock should be calculated as follows: (1) in the first 24h, the amount of fluid (ml) is equal to TBSA (%) x body weight (kg) x 2.6. The ratio between colloid and electrolytes is 1:1, each of the two fluid types is 1.3 ml per (%) TBSA per kg body weight. The volume of water required is 2000 ml. Half of the total amount of fluid is proposed should be infused in the first 2 h after hospitalization under strict monitoring of hemodynamic indices. (2) In the second 24 h, the amount of fluid (ml) is equal to TBSA (%) x body weight (kg) x 1. The ratio between colloid and electrolytes 1:1, each of the two is 0.5 ml. Water volume is 2000 ml.
Huang
Yuesheng
Y
Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University, Chongqing 400038, China. yshuang@public.cta.cq.cn
Yan
Baigang
B
Yang
Zongcheng
Z
D000293:Adolescent; D000328:Adult; D002056:Burns / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D012151:Resuscitation / Q000379:methods*; D012774:Shock, Traumatic / Q000628:therapy*; D013997:Time Factors; D014556:Urine / Q000502:physiology; D014781:Viscera / Q000502:physiology