Document Detail


Esophageal echo-Doppler monitoring in burn shock resuscitation: are hemodynamic variables the critical standard guiding fluid therapy?
MedLine Citation:
PMID:  19077633     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Ever since the introduction of invasive hemodynamic monitoring to major burn care, its utility remains controversial. Besides complications, invasive monitoring as a guideline for burn shock resuscitation is often associated with significant excessive fluid burden. This study was to summarize the clinical experiences of noninvasive esophageal echo-Doppler (ED) monitoring in burn shock resuscitation and discuss the significance of hemodynamic variables in assessment of fluid therapeutic goal. METHODS: Twenty-one burn patients with an average total body surface area of 78.86% +/- 7.75% (62-92%) was enrolled in this retrospective study. Fluid therapy was guided according to Chinese general formula and adjusted with urinary output 1 mL/kg/hr as resuscitation goal. Hemodynamic parameters using ED was obtained, including cardiac output (CO), stroke volume (SV), myocardial contractility parameter--maximum acceleration at onset of systole (Acc), afterload parameter--total systemic vascular resistance (TSVR), preload parameter SV/Acc. RESULTS: All patients were clinically diagnosed with a relatively stable condition during early shock stage. There existed inherent and dynamic tendency of hemodynamics during burn shock resuscitation with low CO, Acc, SV/Acc, and high TSVR at first followed by a continuous trend of increase in CO, Acc and SV/Acc and decrease in TSVR. Significant correlations could be seen between CO and Acc, CO and TSVR, CO and SV/Acc. The Standardized Regression Coefficients of Acc, TSVR, and SV/Acc with CO as dependent variable were 0.343, -0.670, and 0.053, respectively demonstrating that myocardial contractility and angiotasis played more important role than blood volume did in hemodynamic variation. CONCLUSIONS: Hemodynamic variables cannot routinely substitute traditional variables as the burn shock resuscitation goal. Because of its noninvasiveness, ability to real-timely provide complete profile of hemodynamics, ED monitoring is a good adjunctive method for clinical judgment.
Authors:
Guang-Yi Wang; Bing Ma; Hong-Tai Tang; Shi-Hui Zhu; Jian Lu; Wei Wei; Sheng-De Ge; Zhao-Fan Xia
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  65     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-16     Completed Date:  2009-01-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1396-401     Citation Subset:  AIM; IM    
Affiliation:
Department of Burn Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Volume / physiology
Burns / physiopathology,  therapy,  ultrasonography*
Burns, Inhalation / physiopathology,  therapy,  ultrasonography
Cardiac Output / physiology
Echocardiography, Doppler*
Echocardiography, Transesophageal*
Female
Fluid Therapy / methods*
Hemodynamics / physiology*
Humans
Male
Middle Aged
Myocardial Contraction / physiology
Resuscitation / methods*
Retrospective Studies
Shock / physiopathology,  therapy,  ultrasonography*
Stroke Volume / physiology
Systole / physiology
Vascular Resistance / physiology
Young Adult

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