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Fluid Resuscitation in Patients With Severe Burns: A Meta‐analysis of Randomized Controlled Trials
Author(s) -
Kao Yuan,
Loh ElWui,
Hsu ChienChin,
Lin HungJung,
Huang ChienCheng,
Chou YunYun,
Lien ChiehChun,
Tam KaWai
Publication year - 2018
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13333
Subject(s) - medicine , resuscitation , intravascular volume status , meta analysis , cochrane library , total body surface area , randomized controlled trial , anesthesia , shock (circulatory) , hemodynamics , intensive care medicine , surgery
Objectives Fluid resuscitation is the mainstay treatment to reconstitute intravascular volume and maintain end‐organ perfusion in patients with severe burns. The use of a hyperosmotic or isoosmotic solution in fluid resuscitation to manage myocardial depression and increased capillary permeability during burn shock has been debated. We conducted a systematic review and meta‐analysis to compare the efficacies of hyperosmotic and isoosmotic solutions in restoring hemodynamic stability after burn injuries. Methods PubMed, Embase, Cochrane Library, Scopus, and ClinicalTrials.gov registry were searched. Randomized control trials evaluating the efficacy and safety of hyperosmotic and isoosmotic fluid resuscitation in patients with burn injuries were selected. Eligible trials were abstracted and assessed for the risk of bias by two reviewers and results of hemodynamic indicators in the included trials were analyzed. Results Ten trials including 502 participants were published between 1983 and 2013. Compared with isoosmotic group, the hyperosmotic group exhibited a significant decrease in the fluid load (vol/% total body surface area [ TBSA ]/weight) at 24 hours postinjury, with a mean difference of −0.54 (95% confidence interval = −0.92 to −0.17). No differences were observed in the urine output, creatinine level, and mortality at 24 hours postinjury between groups. Conclusions Hyperosmotic fluid resuscitation appears to be an attractive choice for severe burns in terms of TBSA or burn depth. Further investigation is recommended before conclusive recommendation.