Introduction: A number of target points have been used for resuscitation in severely burned patients with conflicting results.
Hypothesis: The aim of our study was to evaluate the use of resuscitation guided transpulmonary thermodilution with targets lower than normal.
Methods: 132 severely burned patients admitted to the critical burn care unit were included into a prospective study over a 26-month period. Cardiac index (CI), Intrathoracic blood volume (ITBV), Extravascular lung water (EVLW) and arterial blood lactates were obtained throughout the first 72h. Fluid therapy was adjusted to achieve a hourly urine output > 0.5 mL/kg, mean arterial pressure> 65 mmHg, CI >2.0 L/min/m2 and ITBV index > 750 mL/m2. When EVLW index exceeded 10 mL/kg and/or the ITBV index exceeded 1000 mL/m2 perfusion fluid was limited and vasoactive drug were introduced. Continuous variables are presented as means and standard deviations
Results: 98 patients were men and 34 were female. Mean age was 48 +/- 18 years, men total body surface area burned was 35.0 +/- 22.1 %, mean Abbreviated Burn Severity Index was 8.2 +/- 2.6 and mortality rate was 27.3%. At admission mean CI was 2.68 +/- 1.06 L/min/m2 and ITBV index was 709 +/- 254 mL/m2 and at 24 hours CI and ITBV index increased to 3.22 +/- 1.12 L/min/m2 and to 744 +/- 276 mL/m2. Arterial blood lactate decreased from 2.58 +/- 2.05 mmol/L at admission to 2.45 +/- 1.78 at 24 h and 1.87 +/- 1.27 at 48 h. The fluid rate required to achieve targets in the first 24 hours was 5.35 +/- 8.06 mL/kg/total body surface area burned (median 4.40). In the first 8 hours de mean infusion rate was 4.05, in the second 8 hours 4.7, in the third 8 hours 5.1 and at 48 h the rate decrease to 3.0 mL/kg/total body surface area burned.
Conclusions: Resuscitation guided by transpulmonary thermodilution with bellow- normal targets is appropriate and requires less fluid than those calculates by Parkland formula in the first 8 hours, but after the requirementes are slightly higher.
(C) 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins