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Delayed hypertonic saline dextran administration after burn injury

J W Horton1, D J White, J L Hunt

  • 1Department of Surgery, University of Texas Southwestern Medical Center, Dallas.

The Journal of Trauma
|February 1, 1995
PubMed
Summary

Administering hypertonic saline dextran (HSD) within 4 hours of burn injury preserves cardiac function and reduces fluid needs. Delaying HSD beyond 4 hours significantly diminishes its cardioprotective benefits in burn patients.

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Area of Science:

  • Burn Injury Research
  • Cardiovascular Physiology
  • Resuscitation Medicine

Background:

  • Severe burns cause significant fluid loss and cardiac dysfunction.
  • Current fluid resuscitation protocols often involve aggressive crystalloid administration.
  • The optimal timing for administering hypertonic saline dextran (HSD) post-burn remains unclear.

Purpose of the Study:

  • To investigate the cardioprotective effects of HSD when administered at different time points after burn injury.
  • To determine if delaying HSD administration impacts its efficacy in maintaining cardiac function.
  • To assess the effect of HSD timing on overall fluid requirements post-burn.

Main Methods:

  • Guinea pigs with severe scald burns (45% TBSA) were resuscitated with lactated Ringer's (LR) according to the Parkland formula.

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  • HSD was administered intravenously at 1, 4, or 8 hours post-burn.
  • Cardiac function (left ventricular pressure, +/- dP/dt) was assessed and compared to LR-only treated and sham burn controls.

    • Main Results:

    • LR alone resulted in significant cardiac dysfunction compared to controls.
    • HSD administration at 1 and 4 hours post-burn (HSD-1, HSD-4) significantly improved cardiac function (LVP, +/- dP/dt).
    • Cardiac function in HSD-1 and HSD-4 groups was comparable to sham burn controls; HSD at 8 hours showed minimal benefit.

    Conclusions:

    • Hypertonic saline dextran (HSD) effectively preserves cardiac function following severe burn injury.
    • Optimal cardioprotection and reduced fluid requirements are achieved when HSD is administered within 4 hours post-burn.
    • Delaying HSD administration beyond 4 hours significantly attenuates its therapeutic benefits.