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Fluid replacement in burned patients

A Bortolani1, M Governa, D Barisoni

  • 11st Division of Plastic and Reconstructive Surgery, Ospedale Civile Maggiore-Verona, Italy.

Acta Chirurgiae Plasticae
|January 1, 1996
PubMed
Summary
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Hypertonic lactated saline (HLS) resuscitation in burn patients requires less fluid and reduces complications compared to ringer lactated saline (RLS). However, HLS may be associated with higher mortality, possibly due to increased Roy index.

Area of Science:

  • Trauma care
  • Burn resuscitation
  • Fluid management

Background:

  • Burn injuries cause significant fluid, electrolyte, and protein loss.
  • Prompt fluid resuscitation is critical to prevent shock after burns.
  • Various resuscitation formulas exist, including saline, colloids, and plasma.

Purpose of the Study:

  • To compare the efficacy of two fluid resuscitation formulas in burn patients.
  • To evaluate the impact of ringer lactated saline (RLS) versus hypertonic lactated saline (HLS) on patient outcomes.
  • To assess fluid and electrolyte balance, organ function, and complication rates.

Main Methods:

  • A randomized study of 40 burn patients with >30% body surface area burns.
  • Patients received either RLS (Baxter formula) or modified HLS (Milan Burn Center).

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  • Assessment included fluid volume, electrolytes, hematocrit, urine output, serum proteins, and complications.
  • Main Results:

    • RLS group received higher fluid volumes and lower sodium than HLS group (p < 0.01).
    • HLS group showed higher potassium administration and metabolic alkalosis.
    • Lower complication rates were observed in the HLS group; however, mortality was higher.

    Conclusions:

    • HLS resuscitation offers a good electrolyte balance with reduced fluid load, potentially minimizing edema and complications.
    • Despite lower complication rates, HLS resuscitation may be linked to increased mortality.
    • Further research is needed to optimize burn resuscitation strategies.