Oral and enteral resuscitation of burn shock the historical record and implications for mass casualty care.
In the aftermath of a mass disaster, standard care methods for treatment of burn injury will often not be available for all victims. A method of fluid resuscitation for burns that has largely been forgotten by contemporary burn experts is enteral resuscitation. We identified 12 studies with over 700 patients treated with enteral resuscitation, defined as drinking or gastric infusion of salt solutions, from the literature. These studies suggest that enteral resuscitation can be an effective treatment for burn shock under conditions in which the standard IV therapy is unavailable or delayed, such as in mass disasters and combat casualties. Enteral resuscitation of burn shock was effective in patients with moderate (10-40% TBSA) and in some patients with more severe injuries. The data suggests that some hypovolemic burn and trauma patients can be treated exclusively with enteral resuscitation, and others might benefit from enteral resuscitation as an initial alternative and a supplement to IV therapy. A complication of enteral resuscitation was vomiting, which occurred less in children and much less when therapy was initiated within the first postburn hour. Enteral resuscitation is contra-indicated when the patient is in "peripheral circulatory collapse". The optimal enteral solution and regimen has not yet been defined, nor has its efficacy been tested against modern IV resuscitation. The oldest studies used glucose-free solutions of buffered isotonic and hypotonic saline. Studies that are more recent show benefit of adding glucose to electrolyte solutions similar to those used in the treatment of cholera. If IV therapy for mass casualty care is delayed due to logistical constraints, enteral resuscitation should be considered.
Kramer
George C
GC
University of Texas Medical Branch (UTMB) and Shriners Burns Hospital, Galveston, and Middlemore Hospital, Auckland, New Zealand.
Michell
Michael W
MW
Oliveira
Hermes
H
Brown
Tim La H
TL
Herndon
David
D
Baker
R David
RD
Muller
Michael
M
Burns. 1998 Aug;24(5):470-4
9725690
J Trauma. 1970 Jul;10(7):575-86
5447485
Gut. 1997 May;40(5):602-7
9203937
J Physiol. 1998 Apr 1;508 ( Pt 1):15-21
9490810
J Pediatr Surg. 1994 Feb;29(2):339-41;discussion 342
8176616
J Clin Invest. 1957 Feb;36(2):303-8
13406042
J Clin Invest. 1975 Apr;55(4):728-37
1120780
Mil Med. 1984 Feb;149(2):55-62
6427656
J Am Med Assoc. 1960 Jun 4;173:509-16
13845020
Public Health Rep (1896). 1950 Oct 13;65(41):1317-20
14776200
J Pediatr Gastroenterol Nutr. 2001 Oct;33 Suppl 2:S2-12
11698779
Ann Surg. 1991 Feb;213(2):177-83
1899551
BMJ. 2001 Oct 6;323(7316):773-6
11588077
Ann Surg. 1997 May;225(5):554-65; discussion 565-9
9193183
Clin Invest Med. 1987 May;10(3):270-4
2887324
Surg Gynecol Obstet. 1987 Feb;164(2):127-36
3810427
Ann N Y Acad Sci. 1968 Aug 14;150(3):874-94
4973463
Clin Sci. 1964 Jun;26:429-43
14191272
Ann Surg. 1947 Dec;126(6):1010-45
17859039
Ann Surg. 1944 Sep;120(3):367-76
17858496
Crit Care Med. 1993 Apr;21(4):527-31
8472572
J Am Med Assoc. 1956 Aug 11;161(15):1465-73
13345608
J Burn Care Rehabil. 2000 Mar-Apr;21(2):91-5
10752739
Aviat Space Environ Med. 1998 Sep;69(9):837-44
9737753
Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi. 1988 Dec;4(4):288-91, 320
3151687
Tex State J Med. 1949 Sep;45(9):635-9
18137612
J Appl Physiol (1985). 1997 Jul;83(1):204-12
9216965
Crit Care Nurse. 1999 Dec;19(6):40-51; quiz 52-3
10889604
Langenbecks Arch Klin Chir Ver Dtsch Z Chir. 1964 Nov 17;308:55-60
14347732
Ann Surg. 1961 Nov;154:803-10
13912109
Ann N Y Acad Sci. 1968 Aug 14;150(3):865-73
5248792
J R Army Med Corps. 2001 Jun;147(2):198-205
11464415
N Engl J Med. 2000 Feb 3;342(5):308-13
10655529
Burns. 2003 Mar;29(2):159-62
12615463
Ann Surg. 1952 Jun;135(6):804-17
14924536
Am J Physiol. 1947 Nov 1;151(1):155-67
20271656
Khirurgiia (Mosk). 1989 Mar;(3):87-90
2498568
Med Sci Sports Exerc. 1993 Jan;25(1):42-51
8423756
Resuscitation. 2000 Jul;45(2):91-6
10950316
Aviat Space Environ Med. 1998 Apr;69(4):374-86
9561285