Document Detail


Hemodynamic changes during resuscitation after burns using the Parkland formula.
MedLine Citation:
PMID:  19204504     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Zoltan Bak; Folke Sjöberg; Olle Eriksson; Ingrid Steinvall; Birgitta Janerot-Sjoberg
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of trauma     Volume:  66     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-02-10     Completed Date:  2009-04-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  329-36     Citation Subset:  AIM; IM    
Affiliation:
Department of Intensive Care, Heart Centre, Linköping University Hospital, Linköping, Sweden. zoltan.bak@lio.se
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MeSH Terms
Descriptor/Qualifier:
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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