[Burn shock, diagnostics, monitoring and fluid therapy of severe burns--new look]

Pathomechanism of burn shock is associated with an important endocrine disorder and cytokines storm. As a result of the burns are released to bloodstream kinins such as: histamine, serotonin and bradykinin and also inflammatory mediators such as: tromboxans, prostacyclins, prostaglandins and leukotrienes. Arises temporary endothelial failure. Comes to the escape of liquid blood to the tissues and a sudden decrease in the quantity of the fluid in the vessels and appear symptoms of burn shock. Offset of fluids by vascular wall to the extravascular space described mathematically with Landis-Starling law. Treatment of burn shock relies on intensive fluid therapy to fill vessels. Fluid rules are based on infusion crystalloids, colloids, hypersaline or plasma. Effect of fluid resuscitation after severe burn are edemas of whole body. Severe burn receives up to 25 000 ml of fluids intravenous in the first 48 hours after injury. The quantity of water defaulting tissue after 48 hours is even 13 000-18 500 ml which is 300-400% of the volume of blood flow. From 3rd day after burn this may produce symptoms of acute circulatory insufficiency or polycompartment syndrom. Enforces this restrictive fluid treatment and removing significant quantities of water from the bloodstream. In East Poland Burn Center and Reconstructive Surgery we remove even 300-350 ml fluid/h by ultrafiltration during CVVHD CiCa. Additional application hemodynamic monitoring such Vigileo-Flotrac has considerably reduce the amount of complications such as: intra-abdominal hypertension IAH, acute heart syndrome, cerebral edema and pulmonary edema.