Circulating blood volume in burn resuscitation.

Area of Science:

• Trauma and Burn Care
• Intravascular Physiology
• Resuscitation Medicine

Background:

• Severe cutaneous burns and smoke inhalation injuries significantly impact patient hemodynamics.
• Understanding intravascular volume status is critical for effective resuscitation in burn patients.

Purpose of the Study:

• To prospectively assess circulating blood volume (CBV) changes in patients with smoke inhalation injury versus severe cutaneous burns.
• To evaluate the effect of these injuries on intravascular volume status up to 96 hours post-injury.
• To compare CBV depletion between smoke inhalation and burn injuries under standard fluid resuscitation protocols.

Main Methods:

• Prospective measurement of circulating blood volume (CBV) using pulse dye-densitometry.
• Inclusion of patients with smoke inhalation injury (n=10) and severe cutaneous burns (n=6).
• Comparison of CBV data against a control group (n=15) of elective surgical patients.
• Standard fluid resuscitation based on the Parkland formula with a target urine output of 1.0-2.0 ml/kg/hr.

Main Results:

• Both groups exhibited low CBV values, indicating intravascular volume depletion despite optimal fluid treatment.
• Group I (smoke inhalation) showed CBV ranging from 70.9% to 77.7% of control values.
• Group B (severe burn) showed CBV ranging from 63.2% to 72.5% of control values.
• No significant difference in CBV was observed between the smoke inhalation and severe burn groups throughout the study.

Conclusions:

• Both smoke inhalation and severe cutaneous burn injuries lead to significant intravascular volume depletion.
• The study highlights the need to consider CBV depletion in early burn management and resuscitation endpoints.
• Hourly urine output may serve as a practical indicator for managing burn patients within permissive hypovolemia.