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Mechanical ventilation and fluid retention in burn patients
David P Mackie1, Ed J Spoelder, Roel J Paauw
1Department of Anesthesiology, Burns Center, Red Cross Hospital, Beverwijk, the Netherlands.
The Journal of Trauma
|December 17, 2009
Summary
Inhalation injury (INHI) does not independently increase fluid retention in burn patients; mechanical ventilation is the primary driver. Early extubation of ventilated patients without INHI is recommended to manage fluid balance.
Area of Science:
- Critical Care Medicine
- Burn Management
- Respiratory Physiology
Background:
- Burn patients with inhalation injury (INHI) often require increased fluid resuscitation.
- The role of mechanical ventilation in fluid retention in these patients is not fully understood.
- This study investigates if INHI independently contributes to fluid retention beyond the effects of ventilation.
Purpose of the Study:
- To determine if inhalation injury (INHI) independently increases fluid retention in burn patients.
- To differentiate the effects of INHI from continuous positive pressure ventilation (CPPV) on fluid balance.
- To inform fluid resuscitation strategies and ventilation management in burn care.
Main Methods:
- Retrospective study of 186 burn patients (>20% TBSA) between 1995-2006.
- Patients categorized into three groups: no INHI/no ventilation, no INHI/ventilation, and INHI/ventilation.
- Cumulative fluid balance calculated at days 3 and 7 postburn, with adjustments for age, weight, and burn TBSA.
Main Results:
- Mechanically ventilated patients were older with more extensive burns.
- Fluid balance was significantly higher in ventilated patients compared to non-ventilated patients, irrespective of INHI.
- The presence of INHI did not significantly increase fluid retention beyond the effects of ventilation.
Conclusions:
- Increased fluid retention in burn patients is primarily attributed to mechanical ventilation (CPPV), not inhalation injury (INHI) itself.
- This finding suggests that ventilation strategies, particularly early extubation in non-INHI patients, may be crucial for optimizing fluid management.
- Further evaluation of ventilated patients without INHI is warranted to refine treatment protocols.
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