[Hypovolemia and oxidative stress in patients with burn injuries]

Adequate treatment of the developing hypovolemia caused by marked oedema formation plays a key role in the care of burned patients. Oxidative stress may be an underlying cause of the excessive oedema formation. The aim of the study was to asses how can different resuscitation schemata be adapted better to the requirement of each individual patient. Effect of the use of different schemata on organ-function and developing oxidative stress and correlation between the extent of burn and oxidative stress has also been studied.

Patients admitted to our level one intensive ward were involved in the study. Inclusion criterion was the start of our fluid resuscitation schema at least 3 hours after injury. Hemodynamic measurements were performed by transpulmonary thermodilution technique. Blood samples were taken on admission and on the 5 consecutive days thereafter. White blood cell count of the patients, the percentage of granulocytes, lymphocytes and monocytes, the levels of malondialdehyde, protein sulfhydryl groups in plasma, reduced glutathione, catalase, and superoxide dismutase enzyme activities, and phorbol myristate acetate induced free radical generating capacity were assessed.

Significantly more fluid was administered than predicted by the Parkland formula (p < 0.05). Patients in whom fluid resuscitation was guided by invasive hemodynamic parameters ScvO 2 was significantly higher (p < 0.05), multi organ dysfunction scores were lower (p < 0.05) than in the hourly urine output group. Patients whom fluid resuscitation was guided by invasive hemodynamic parameters relative number of the granulocytes and maximal rate of reactive oxygen species production (p < 0.05) were significantly higher (p < 0.05), the lag phases were significantly shorter (p < 0.05).

With the use of correction factors the Parkland formula can be more precise, still, fluid resuscitation guided by invasive hemodynamic measurements can provide the best results. The type of fluid resuscitation schema influences mainly the pro-oxidant system.