Plasma exchange therapy in patients failing to resuscitate from burn shock

Irreversible burn shock results from failure of fluid resuscitation and is almost invariably fatal. Because of the implied role of circulating serum factors in the generation of burn shock, the use of plasma exchange was evaluated retrospectively in patients with major thermal injuries who had failed to respond to conventional therapy. Twenty-two patients with a mean burn size of 47.9% total body surface area and a mean age of 22.7 years underwent plasma exchange for ongoing burn shock after standard fluid resuscitation failed. A therapeutic response was documented in 95.4% of the patients, characterized by a sharp decrease in fluid requirements from a mean of 260% above the predicted hourly volume to within calculated requirements by 2.3 hours following plasma exchange. Markedly improved urine output and resolution of lactic acidosis were also demonstrated. No major complications occurred. We conclude that plasma exchange facilitates resuscitation from burn shock in a select group of patients who do not respond to conventional volume therapy.