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EARLY FLUID TREATMENT OF SEVERE BURNS: HEMODYNAMIC ALTERATIONS AND THE USE OF DEXTRAN AND BLOOD
Author(s) -
Haynes B. W.
Publication year - 1968
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.1968.tb14741.x
Subject(s) - fluid replacement , blood volume , hemodynamics , medicine , anesthesia , blood pressure , third degree burn , cardiac output , dextran , intravascular volume status , vascular resistance , surgery , chemistry , biochemistry
SUMMARY The early fluid treatment of severe burns at the Medical College of Virginia has emphasized replacement therapy, adequate quantities of electrolyte, water and colloid with the Evans’ Formula as a clinical reference. The use of dextran over a 15‐year‐period has been associated with good clinical response and circulatory maintenance and freedom from reaction. As a rule, the quantities of red cells destroyed during the first 48 hr are sufficiently small as to make the need for red cell replacement unnecessary. Significant red cell transfusion after this period is required commonly. Hemodynamic alterations after severe burns may be divided into three phases. The first phase generally lasts one to two days and is characterized initially by hypotension, which will respond rapidly to plasma volume expansion. Blood pressure becomes normal while blood volume is deficient and cardiac output is low. Total peripheral resistance is increased. A second or intermediate phase occurs after the first or second day and is characterized by maintenance of a normal blood pressure, a progressive increase in plasma volume, and a falling peripheral resistance coincident with a rising cardiac output. Therapeutic support emphasizes fluid and electrolyte maintenance, replacement of red cell deficits, and good nutrition, leading to wound healing and recovery. A third and terminal phase may occur in the extensive burn (4 to 20 days post‐burn) in which the blood pressure falls gradually. Shortly after hypotension occurs, the cardiac output may be normal or elevated, but falls with persistent hypotension. Blood volume expansion and vasoconstrictors may be of only temporary benefit. The control of sepsis may be the crucial point in maintaining circulatory efficiency.