A Retrospective Study Of Fluid Resuscitation For Massive Burn Patients In Twenty Years

BackgroudLarge area burn damage the skin barrier, increase local vascular permeability, cause large volumes of intravascular fluid extravasation, eventually lead to hypovolemic shock.. By now there are no effective clinical methods to block permeability of microvessels in burn shock, therefore, fluid resuscitation therapy is still the chief way to treat shock in patients with severe burn.At present, the volume of fluid resuscitation rely mainly on formulas which were put forward by Third minitary medical unversity50years before. Chinese southern region is subtropical area with perennial wet, hot oceanic climate, local burn patients may suffer different fluid loss property from the inland areas. According to the local climate characteristics and our clinical experiences in20years, we made some exploratory improvement in rehydration therapy. Specifically, increasing fluid volume and the fluid composition based on the traditional rehydration formula.In this study we analyzed94cases of adult burn patients (18-50years old, within8hours of admission, with complete rehydration data, excluding factors which impact shock resuscitation, trauma and injury before admission) of large area burned respectively during recent twenty years. We set visceral complications in shock stage within10days as an importante evaluation. We hope to find the relationship between incidence and mortality of visceral complications and improving resuscitation solution. We look forward to find a suitable fluid resuscitation solution and experience for severe burn patients in shock stage in Guangzhou region.ObjectiveTo analyze the resuscitation experience of adult patients with severe burn in the area of Guangzhou during20years, we compared the occurrence of visceral complications in10days and analyzed the relationship with age, TBSA, hospitalized time, and the volume of resuscitation and the fluid composition. We hope to find an improved treatment for severe burn patients in shock stage.MethodsClinical data of adult patients with burn area greater than or equal to TBSA50%were collected in twenty years and94patients entered the study(18-50years old, within8hours of admission, with complete rehydration data, excluding factors which impact shock resuscitation, trauma and injury before admission). They were divided into two groups according to the presence or absence of visceral complications (in10days)Firstly, single factor analysis of variance was made in patients having visceral as following:1. the time of admission, weight, TBSA and tracheal incision rate;2. the total fluid resuscitation volume, crystals, colloids and water components fluid volume and urine output in shock stage;3. comparing the difference of crystalline colloidal actual fluid volume and formula rehydration guiding volume in two groups of patients. Secondly, the single factor analysis of P<0.10variables into regression equation in multiple Logistic regression analysis, with visceral complications as the dependent variable, the selection of the research factors as independent variables.ResultsThere are3variates in factor analysis(P<0.10):the crystal volumes of actual infusion minus the volumes according to rehydration formula、the surface area of three degree burn and urinary volume in the second24hours. Our results showed that three factors will cause visceral complications based on the a multivariate Logistic regression analysis results:1、The actual crystal fluid rehydration volume1037ml less than formula in the first24hours.2、The urinary volume in the second24hours less than1390ml.3、The surface area of three degree burn less than45%TBSA.Conclusions1、The treatment for adult burn patients of TBSA>50%should considerate both regional climate characteristics and individual factors based on individualized rehydration formula.2、Patients with larger area of Ⅲ degree burns more likely have visceral complications, which indicate that more fluid volume were needed than the formula guide. Furthermore, for those patients, besides fluid resuscitation treatment, comprehensive treatment model need to be applicated including tissue ischemia and hypoxia improvement and oxygen free radical scavenging, etc.All in all, in the treatment of early stage of large area burn patients, emphasis shoud be put into the individual rehydration.