Early fluid resuscitation with hyperoncotic hydroxyethyl starch 200/0.5 (10%) in severe burn injury.
BACKGROUND
Despite large experience in the management of severe burn injury, there are still controversies regarding the best type of fluid resuscitation, especially during the first 24 hours after the trauma. Therefore, our study addressed the question whether hyperoncotic hydroxyethyl starch (HES) 200/0.5 (10%) administered in combination with crystalloids within the first 24 hours after injury is as effective as 'crystalloids only' in severe burn injury patients.


METHODS
30 consecutive patients were enrolled to this prospective interventional open label study and assigned either to a traditional 'crystalloids only' or to a 'HES 200/0.5 (10%)' volume resuscitation protocol. Total amount of fluid administration, complications such as pulmonary failure, abdominal compartment syndrome, sepsis, renal failure and overall mortality were assessed. Cox proportional hazard regression analysis was performed for binary outcomes and adjustment for potential confounders was done in the multivariate regression models. For continuous outcome parameters multiple linear regression analysis was used.


RESULTS
Group differences between patients receiving crystalloids only or HES 200/0.5 (10%) were not statistically significant. However, a large effect towards increased overall mortality (adjusted hazard ratio 7.12; P = 0.16) in the HES 200/0.5 (10%) group as compared to the crystalloids only group (43.8% versus 14.3%) was present. Similarly, the incidence of renal failure was 25.0% in the HES 200/0.5 (10%) group versus 7.1% in the crystalloid only group (adjusted hazard ratio 6.16; P = 0.42).


CONCLUSIONS
This small study indicates that the application of hyperoncotic HES 200/0.5 (10%) within the first 24 hours after severe burn injury may be associated with fatal outcome and should therefore be used with caution.


BACKGROUND
NCT01120730.
Béchir
Markus
M
Division of Surgical Intensive Care, University Hospital of Zurich, Raemistrasse 100, Zurich 8091, Switzerland. markus.bechir@usz.ch
Puhan
Milo A
MA
Neff
Simona B
SB
Guggenheim
Merlin
M
Wedler
Volker
V
Stover
John F
JF
Stocker
Reto
R
Neff
Thomas A
TA
D000328:Adult; D000368:Aged; D002056:Burns / Q000628:therapy*; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000494:pharmacology*; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000494:pharmacology*; D011446:Prospective Studies; D012044:Regression Analysis; D015599:Trauma Severity Indices; D016896:Treatment Outcome
D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes