Hypertonic lactated saline resuscitation of severely burned patients over 60 years of age

Twenty-six adults more than 60 years old with burns greater than or equal to 30% of the body surface area were resuscitated using hypertonic lactated saline (HLS). Hemodynamic parameters of resuscitation were measured in ten of the patients using a Swan-Ganz catheter. In spite of signs of hemodynamic stability, these patients demonstrated mean cardiac indices (CI) below their age-corrected norms and pulmonary capillary wedge pressures (PCWP) below 5 mm Hg through 24 hours, yet 92% of the patients produced normal or super-normal volumes of urine. Hemodynamic monitoring may be helpful for precise fluid replacement in extensively burned elderly patients; however, a normal CI and PCWP may not be the appropriate endpoint for resuscitation of the elderly when using HLS. This review supports the concept that HLS resuscitation of critically burned older patients is both safe and efficacious, leading to an 81% survival of this severely compromised group well past the resuscitation phase of injury.