Document Detail


Colloid administration normalizes resuscitation ratio and ameliorates "fluid creep".
MedLine Citation:
PMID:  20061836     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Although colloid was a component of the original Parkland formula, it has been omitted from standard Parkland resuscitation for over 30 years. However, some burn centers use colloid as "rescue" therapy for patients who exhibit progressively increasing crystalloid requirements, a phenomenon termed "fluid creep." We reviewed our experience with this procedure. With Institutional Review Board approval, we reviewed all adult patients with > or =20%TBSA burns admitted from January 1, 2005, through December 31, 2007, who completed formal resuscitation. Patients were resuscitated using the Parkland formula, adjusted to maintain urine output of 30 to 50 ml/hr. Patients who required greater amounts of fluid than expected were given a combination of 5% albumin and lactated Ringer's until fluid requirements normalized. Results were expressed as an hourly ratio (I/O ratio) of fluid infusion (ml/kg/%TBSA/hr) to urine output (ml/kg/hr). Predicted values for this ratio vary for individual patients but are usually less than 0.5 to 1.0. Fifty-two patients were reviewed, of whom 26 completed resuscitation using crystalloid alone, and the remaining 26 required albumin supplementation (AR). The groups were comparable in age, gender, weight, mortality, and time between injury and admission. AR patients had larger total and full-thickness burns and more inhalation injuries. Patients managed with crystalloid alone maintained mean resuscitation ratios from 0.13 to 0.40, whereas AR patients demonstrated progressively increasing ratios to a maximum mean of 1.97, until albumin was started. Administration of albumin produced a dramatic and precipitous return of ratios to within predicted ranges throughout the remainder of resuscitation. No patient developed abdominal compartment syndrome. Measuring hourly I/O ratios is an effective means of expressing and tracking fluid requirements. The addition of colloid to Parkland resuscitation rapidly reduces hourly fluid requirements, restores normal resuscitation ratios, and ameliorates fluid creep. This practice can be applied selectively as needed using predetermined algorithms.
Authors:
Amanda Lawrence; Iris Faraklas; Holly Watkins; Ashlee Allen; Amalia Cochran; Stephen Morris; Jeffrey Saffle
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of burn care & research : official publication of the American Burn Association     Volume:  31     ISSN:  1559-0488     ISO Abbreviation:  J Burn Care Res     Publication Date:    2010 Jan-Feb
Date Detail:
Created Date:  2010-01-11     Completed Date:  2010-05-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101262774     Medline TA:  J Burn Care Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  40-7     Citation Subset:  IM    
Affiliation:
Burn Trauma ICU, Department of Surgery, University of Utah College of Medicine, Salt Lake City, Utah, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Algorithms
Burns / complications,  pathology,  therapy*
Cohort Studies
Colloids
Female
Fluid Therapy*
Humans
Infusions, Intravenous
Isotonic Solutions / therapeutic use*
Male
Middle Aged
Plasma Substitutes / therapeutic use*
Retrospective Studies
Serum Albumin / administration & dosage*
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Colloids; 0/Isotonic Solutions; 0/Plasma Substitutes; 0/Serum Albumin; 0/crystalloid solutions

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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