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Arterial thermodilution in burn patients suggests a more rapid fluid administration during early resuscitation
Author(s) -
CSONTOS C.,
FOLDI V.,
FISCHER T.,
BOGAR L.
Publication year - 2008
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2008.01658.x
Subject(s) - medicine , resuscitation , anesthesia , hemodynamics , total body surface area , fluid replacement , cardiac output , intensive care unit , intravascular volume status , intensive care , urine output , surgery , intensive care medicine , creatinine
Background: A number of target points have been used for fluid replacement in severely burned patients. The aim of our prospective randomized study was to compare the effect of two different types of fluid resuscitation regimes on the multiple organ dysfunction score (MODS) and central venous oxygen saturation (ScvO 2 ) in the first 3 days after injury. Methods: Twenty‐four patients admitted to the critical care unit of a university hospital with the presence of burn injury affecting more than 15% of the body surface area and in‐hospital fluid resuscitation started within 3 h after burn injury were included. Patients were randomized into two groups. Fluid resuscitation was guided by the hourly urine output (HUO Group, n =12) or by the intrathoracic blood volume index (ITBVI Group, n =12). Invasive transpulmonary hemodynamic measurements utilizing pulse contour analysis with a single dilution technique and continuous ScvO 2 measurements were performed in both groups. Results: The mean ScvO 2 was significantly lower in the HUO Group than in the ITBVI Group ( P =0.024) for the first 24 h. MODS was significantly higher in the HUO Group than in the ITBVI group 48 h ( P =0.024) and 72 h after injury ( P =0.014). The two main outcome parameters, i.e., MODS calculated at 48 and 72 h after injury and ScvO 2 were negatively correlated on day 1 ( r =−0.684, P =0.004, r =−0.677, P =0.003). There were no statistical differences in clinical outcome parameters. Conclusion: Our data suggest that ITBVI may be a better target parameter than HOU in the fluid resuscitation of severely burned patients after injury.