| Hemodynamic changes during resuscitation after burns using the Parkland formula. | |
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MedLine Citation:
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PMID: 19204504 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The Parkland formula (2-4 mL/kg/burned area of total body surface area %) with urine output and mean arterial pressure (MAP) as endpoints for the fluid resuscitation in burns is recommended all over the world. There has recently been a discussion on whether central circulatory endpoints should be used instead, and also whether volumes of fluid should be larger. Despite this, there are few central hemodynamic data available in the literature about the results when the formula is used correctly. METHODS: Ten burned patients, admitted to our unit early, and with a burned area of >20% of total body surface area were investigated at 12, 24, and 36 hours after injury. Using transesophageal echocardiography, pulmonary artery catheterization, and transpulmonary thermodilution to monitor them, we evaluated the cardiovascular coupling when urinary output and MAP were used as endpoints. RESULTS: Oxygen transport variables, heart rate, MAP, and left ventricular fractional area, did not change significantly during fluid resuscitation. Left ventricular end-systolic and end-diastolic area and global end-diastolic volume index increased from subnormal values at 12 hours to normal ranges at 24 hours after the burn. Extravascular lung water: intrathoracal blood volume ratio was increased 12 hours after the burn. CONCLUSIONS: Preload variables, global systolic function, and oxygen transport recorded simultaneously by three separate methods showed no need to increase the total fluid volume within 36 hours of a major burn. Early (12 hours) signs of central circulatory hypovolemia, however, support more rapid infusion of fluid at the beginning of treatment. |
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Authors:
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Zoltan Bak; Folke Sjöberg; Olle Eriksson; Ingrid Steinvall; Birgitta Janerot-Sjoberg |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Journal of trauma Volume: 66 ISSN: 1529-8809 ISO Abbreviation: J Trauma Publication Date: 2009 Feb |
Date Detail:
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Created Date: 2009-02-10 Completed Date: 2009-04-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376373 Medline TA: J Trauma Country: United States |
Other Details:
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Languages: eng Pagination: 329-36 Citation Subset: AIM; IM |
Affiliation:
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Department of Intensive Care, Heart Centre, Linköping University Hospital, Linköping, Sweden. zoltan.bak@lio.se |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Analysis of Variance Body Surface Area Burns / physiopathology*, therapy* Catheterization, Swan-Ganz Echocardiography, Transesophageal Female Fluid Therapy / methods* Hemodynamics Humans Intermittent Positive-Pressure Ventilation Male Middle Aged Oxygen Consumption Resuscitation / methods* Thermodilution |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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