title: An overview on fluid resuscitation and resuscitation endpoints in burns: Past, present and future. Part 1 - historical background, resuscitation fluid and adjunctive treatment.
abstract: An improved understanding of burn shock pathophysiology and subsequent development of fluid resuscitation strategies has led to dramatic outcome improvements in burn care during the 20th century. While organ hypoperfusion caused by inadequate resuscitation has become rare in clinical practice, there is growing concern that increased morbidity and mortality related to over-resuscitation is occurring more frequently in burn care. In order to reduce complications related to this concept of "fluid creep", such as respiratory failure and compartment syndromes, efforts should be made to resuscitate with the least amount of fluid in order to provide adequate organ perfusion. In this first part of a concise review, historic and current evidence regarding the available fluids is discussed, as well as some adjunctive treatments modulating the inflammatory response. In the second part, special reference will be made to the role of abdominal hypertension in burn care and the endpoints used to guide fluid resuscitation will be discussed. Finally, as urine output has been recognized as a poor resuscitation target, a resuscitation protocol is suggested in part two which includes new targets and endpoints that can be obtained with modern, less invasive hemodynamic monitoring devices.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Peeters
authors.forename: Stefanie
authors.initials: S
authors.lastname: Vandervelden
authors.forename: Robert
authors.initials: R
authors.lastname: Wise
authors.affiliation: ICU and High Care Burn Unit, ZiekenhuisNetwerk Antwerpen, ZNA Stuivenberg, Antwerpen, Belgium. manu.malbrain@skynet.be.
authors.forename: Manu L N G
authors.initials: ML
authors.lastname: Malbrain
mesh_terms: D000418:Albumins / Q000008:administration & dosage; D001205:Ascorbic Acid / Q000627:therapeutic use; D002056:Burns / Q000628:therapy*; D003102:Colloids / Q000008:administration & dosage; D000077324:Crystalloid Solutions; D023381:Endpoint Determination; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage; D010956:Plasmapheresis; D012151:Resuscitation / Q000379:methods*
chemical_list: D000418:Albumins; D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D001205:Ascorbic Acid
keywords: adjunctive treatments; albumin; burns; colloid; crystalloid; fluid resuscitation; resuscitation endpoint/target; treatment