title: Vasoconstrictor clysis in burn surgery and its impact on outcomes: systematic review and meta-analysis.
abstract: OBJECTIVE
  Clysis is the subcutaneous or subdermal injection of a vasopressor containing fluid, with or without local anaesthetic agent, and has been used to limit blood loss in patients undergoing surgical burn management. In this systematic review and meta-analysis we aimed to determine the impact of clysis of a vasoconstrictor on burn patient outcomes.
  
  
  METHODS
  We conducted a systematic review to identify trials investigating clysis in burn patients undergoing debridement and/or skin grafting. For each eligible trial we aimed to extract the outcomes of perioperative blood loss, blood transfusion, duration of surgery, graft success and healing time, inflammatory response, sepsis, mortality, duration of hospital stay, catecholamine levels and cardiovascular effects in both the short (<72h) and long term (30 days) after surgery.
  
  
  RESULTS
  From 443 citations, we selected 39 for full-text evaluation, and identified 10 eligible trials. Due to a lack of reporting on outcomes of interest, meta-analysis could only be conducted for the outcome of red blood cell (RBC) units transfused per patient. Patients receiving clysis (n=222) were transfused 1.89 less units (95% CI -2.12 to -1.66) as compared to those not receiving clysis, although this was associated with a high degree of heterogeneity (I(2)=88%).
  
  
  CONCLUSIONS
  Few studies have adequately evaluated the impact of clysis in burn surgery on patient important outcomes such mortality, duration of surgery and graft success. These results suggest clysis may reduce the need for blood transfusion but additional high quality research is required.
authors.affiliation: Pietermaritzburg Metropolitan Complex, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa. Electronic address: nikkiallorto@gmail.com.
authors.forename: N L
authors.initials: NL
authors.lastname: Allorto
authors.affiliation: Pietermaritzburg Metropolitan Complex, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa.
authors.forename: D G
authors.initials: DG
authors.lastname: Bishop
authors.affiliation: Pietermaritzburg Metropolitan Complex, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa.
authors.forename: R N
authors.initials: RN
authors.lastname: Rodseth
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002056:Burns / Q000601:surgery*; D003646:Debridement / Q000379:methods*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007279:Injections, Subcutaneous; D061646:Operative Time; D016038:Skin Transplantation / Q000379:methods*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents
keywords: Blood loss; Burn surgery; Clysis