Background; Some studies have supported the opinion that patients who get greater volumes of resuscitation fluids are at a higher chance of edema, complications, and probably bad outcomes. In the results of the International Society of Burn Injuries approximately half (49.5%) added colloid before 24h.
This study aims to analyze the relative risk for mortality comparing resuscitation in the first 24 hours with Parkland and resuscitation with the use of Colloids.
Material and Methods; This was an observational prospective cohort study conducted in the Service of Burns of the University Hospital Centre "Mother Teresa" in Tirana (UHCT), Albania. The study includes adult patients with critical burns > 40% TBSA, hospitalized in the Intensive Care Unit of the service during the period 2014 to 2019. Resuscitation in the first 24 hours is done with Ringer Lactate according to Parkland and with Ringer Lactate with the addition of colloids after 12 hours.
Results; The data for organ dysfunction and organ insufficiency were the same in the two groups without statistical significance. Mortality in the RL group was 48% (24 deaths of 50 patients) while in the RL + Colloid rehydrated group was 46% (23 deaths of 50 patients). Patients which have 40-60% burns and are rehydrated with RL + Colloids have a risk of death 0.4 times less than those rehydrated with RL.
Conclusions; Resuscitation with Ringer lactate and Colloids in the first 24 hours of thermal damage is a rehydration alternative for the treatment of burn shock. This therapy especially helps patients with major burns > 40% TBSA who during rehydration require large amounts of fluids and are associated with severe plasma hypoalbuminemia. Number Need to Treat (NNT benefit) is 10 so 1 in 10 patients can benefit in lowering the risk of death with RL + Colloid rehydration.
Greenhalgh DG. Burn resuscitation. J Burn Care Res 2007; 28:555–65.
Saffle JI. The phenomenon of “fluid creep” in acute burn resuscitation. J Burn Care Res 2007; 28:382–95.
Haberal M, Sakallioglu Abali AE, Karakayali H. Fluid management in major burn injuries. Indian J Plast Surg. 2010;43(Suppl): S29-S36. https://dx.doi.org/10.4103%2F0970-0358.70715
Greenhalgh DG. Burn resuscitation: the results of the ISBI/ABA survey. Burns. 2010 Mar;36(2):176-82.
Cochrane Injuries Group Albumin Reviewers. Human albumin administration in critically ill patients: a systematic review of randomized controlled trials. BMJ 1998; 317:235–40.
SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004; 350: 2247–56.
Charpentier J, Mira J-P. Efficacy and tolerance of hyperoncotic albumin administration in septic shock patients: the EARSS study. Intensive Care Med 2011;37(Suppl 1): S115.
Caironi P, Tognoni G, Masson S, et al.; ALBIOS Study Investigators. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med 2014; 370:1412–21
Bacomo FK, Chung KK. A primer on burn resuscitation. J Emerg Trauma Shock. 2011 Jan;4(1):109-13.
Cancio LC, Mozingo DW, Pruitt BA Jr. The technique of fluid resuscitation for patients with severe thermal injuries. J Crit Illn 1997; 12: 183‐ 90.
Park SH, Hemmila MR, Wahl WL. Early albumin use improves mortality in difficult to resuscitate burn patients. J Trauma Acute Care Surg 2012; 73: 1294‐ 7.
Cope O, Moore FD. The redistribution of body water and the fluid therapy of the burned patient. Ann Surg 1947; 126:1010–45.
Evans EI, Purnell OJ, Robinett PW, Batchelor A, Martin M. Fluid and electrolyte requirements in severe burns. Ann Surg 1952; 135:804–17.
Janeway CA, Gibson ST, Woodruff LM, Heyl JT, Bailey OT, Newhouser LR. Chemical, clinical, and immunological studies on the products of human plasma fractionation VII. Concentrated human serum albumin. J Clin Invest 1944; 23:465–90
Pruitt BA Jr. Protection from excessive resuscitation: “pushing the pendulum back”. J Trauma 2000; 49:567–8.
Pham TN, Cancio LC, Gibran NS; American Burn Association. American Burn Association practice guidelines burn shock resuscitation. J Burn Care Res 2008; 29:257–66
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