Hydroxyethylstarch supplementation in burn resuscitation--a prospective randomised controlled trial.
BACKGROUND
Hydroxyethylstarches (HES) are thought to be beneficial in trauma and major surgery management, due to their volume expansion and anti-inflammatory properties. This study examined the use of 6% (HES) in burn resuscitation.


METHODS
26 adult patients with burns exceeding 15% total body surface area (TBSA) were randomised to either crystalloid (Hartmann's solution) or a colloid-supplemented resuscitation regime, where 1/3 of the crystalloid-predicted requirement was replaced by 6% HES.


RESULTS
There was no difference in age, gender or TBSA between the two groups. The median (95% CI) fluid volume/%TBSA received in the first 24 h was 307 ml and 263 ml for the crystalloid only and HES-supplemented group respectively (p=0.0234, Mann-Whitney). Body weight gain within the first 24 h after injury was significantly lower in the HES-supplemented group 2.5 kg versus 1.4 kg respectively (p=0.0039). The median (95% CI) serum C-reactive protein at 48 h after injury was 210 (167-257) and 128 (74-145) mg/L for the crystalloid only and HES-supplemented group respectively (p=0.0001). Albumin-creatinine ratio per % burn (ACR, a marker of capillary leak) was lower in the HES-supplemented group at 12h after burn (p=0.0310).


CONCLUSIONS
Patients treated with HES-supplemented resuscitation required less fluid, showed less interstitial oedema and a dampened inflammatory response compared to patients receiving isotonic crystalloid alone.
Vlachou
E
E
Burns and Plastic Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK. lilly@doctors.org.uk
Gosling
P
P
Moiemen
N S
NS
D000328:Adult; D000418:Albumins / Q000032:analysis; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002056:Burns / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D002097:C-Reactive Protein / Q000032:analysis; D003404:Creatinine / Q000097:blood; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D007668:Kidney / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D015430:Weight Gain; D055815:Young Adult
D000418:Albumins; D000893:Anti-Inflammatory Agents; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D002097:C-Reactive Protein; D003404:Creatinine