[Pre- and intra-hospital over-resuscitation in burns: frequent and deleterious].
Major burns are characterized by an initial capillary leak which requires fluid resuscitation for hemodynamic stabilisation. While under-resuscitation was the major cause of death until the 80ies, over-resuscitation has become an important source of complications: abdominal compartment syndrome, escharotomies, impaired gas exchange and prolonged mechanical ventilation and hospital stay. The fluid creep started in the 90ies with an increasing proportion of the first 24 hours' fluid delivery above the 4 ml/kg/% BSA Parkland prediction. The first alerts were published under the form of case reports of increased mortality due to abdominal compartment syndrome and respiratory failure. The paper analyses the causes of this fluid creep, and the ways to prevent it, which includes rationing prehospital fluid delivery, avoiding early colloids and permissive hypovolemia.
Service de médecine intensive adulte et Centre des brûlés, CHUV, 1011 Lausanne. mette.berger@chuv.ch
Mette M
MM
Berger
Jean-Pierre
JP
Revelly
Pierre-Nicolas
PN
Carron
Marc-André
MA
Bernath
D001830:Body Surface Area; D002056:Burns / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003102:Colloids / Q000008:administration & dosage / Q000009:adverse effects; D003161:Compartment Syndromes / Q000209:etiology; D003422:Critical Care / Q000379:methods*; D004636:Emergency Service, Hospital; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007902:Length of Stay; D012151:Resuscitation / Q000009:adverse effects / Q000379:methods*; D012720:Severity of Illness Index
D003102:Colloids