Burns: military options and tactical solutions
Steven J Thomas1, George C Kramer, David N Herndon
1Department of Surgery, The University of Texas Medical Branch, Galveston 77555-0801, USA.
The Journal of Trauma
|May 28, 2003
Summary
Military burn resuscitation faces fluid volume challenges. Novel oral rehydration solutions show promise in restoring plasma volume and improving hemodynamics in a porcine burn model, offering a potential volume-sparing strategy.
Area of Science:
- Military medicine
- Trauma resuscitation
- Burn injury management
Background:
- Burn injuries present significant morbidity and mortality, especially in military settings.
- Logistical constraints in combat zones limit traditional large-volume crystalloid resuscitation.
- Thermal injury necessitates immediate and sustained fluid resuscitation, precluding hypotensive strategies.
Purpose of the Study:
- To examine the physiology and traditional resuscitation strategies for thermal injury.
- To evaluate novel fluid resuscitation regimens, including oral rehydration, for burn injuries.
- To present experimental data on oral resuscitation in a porcine burn model.
Main Methods:
- Review of burn resuscitation physiology and traditional strategies.
- Analysis of early colloid or hypertonic saline use.
- Experimental infusion of oral rehydration solution (ORS) via gastric and intestinal routes in a porcine burn model.
Main Results:
- Early use of colloids or hypertonic saline may be volume-sparing temporarily but does not necessarily reduce mortality compared to lactated Ringer's.
- Gastric and intestinal ORS infusions in a porcine burn model restored plasma volumes.
- ORS administration improved hemodynamic parameters, with significant gastric emptying and intestinal absorption observed.
Conclusions:
- Novel resuscitation strategies, including oral rehydration, may offer volume-sparing benefits in the initial management of burn injuries.
- Oral resuscitation demonstrates potential for restoring plasma volume and stabilizing hemodynamics in burn patients.
- Further research into oral resuscitation could provide a vital, logistically feasible option for combat casualty care.
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