Cardiac support in burned patients with heart disease

The author describes the hemodynamic changes typical of burn shock and burn disease and emphasises the typical features of the phases of burn shock ("ebb", "flow"). The author also stresses that the myocardial insufficiency of the burned patients is due to the changes of preload-afterload, disturbances of the myocardial compliance and desynchronisation of the left-right ventricular function. If the injured were pretraumatically heart patients (COCM, ischemic heart disease) fluid replacement in these cases is an appropriate heart therapy. The choice of further treatment is based upon normalization of PVR, TPR "compliance" and oxygenization of myocardium. In the "ebb" phase of shock vasodilators and Ca-entry blockers, in the "flow" phase beta-adrenergic blockers are suggested. In every severe case due to ischemia induced by metabolic and hemodynamic changes, NG (and derivatives) treatment is justified. The author considers the application of positive inotropic agents in all the cases as unreasonable and proves their necessity (Dobutrex, Digoxin) only after objective determination of decreased contractility.