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1086: TRANSPULMONARY THERMODILUTION IN BURN CRITICAL CARE. WHICH SHOULD BE THE END POINT OF THE RESUSCITATION?

Sanchez, Manuel; Herrero, Eva; Perales, Eva; Cachafeiro, Lucia; Denia, Ramon; Agrifoglio, Alexander; Hernandez, Monica; Irazabal, Marian; De Lorenzo, Abelardo Garcia

doi: 10.1097/01.ccm.0000425299.89190.8a
Poster: ABSTRACT Only

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.

Unidad de Quemados Critidos. Servico Medicina Intensiva. Hospital La Paz

Unidad de Quemados Criticos. Servicio Medicina Intensiva. Hospital La Paz

Hospital Universitario La Paz

Unidad de Quemados Criticos. Servicio de Medicina Intensiva. Hospital Universitario La Paz

Hospital Univeristario La Paz

Hospital Universitario La Paz

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins