Document Detail


Optimized fluid management improves outcomes of pediatric burn patients.
MedLine Citation:
PMID:  22703982     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: One of the major determinants for survival of severely burned patients is appropriate fluid resuscitation. At present, fluid resuscitation is calculated based on body weight or body surface area, burn size, and urinary output. However, recent evidence suggests that fluid calculation is inadequate and that over- and under-resuscitations are associated with increased morbidity and mortality. We hypothesize that optimizing fluid administration during the critical initial phase using a transcardiopulmonary thermodilution monitoring device (pulse contour cardiac output [PiCCO]; Pulsion Medical Systems, Munich, Germany) would have beneficial effects on the outcome of burned patients.
METHODS: A cohort of 76 severely burned pediatric patients with burns over 30% of the total body surface area who received adjusted fluid resuscitation using the PiCCO system were compared with 76 conventionally monitored patients (C). Clinical hemodynamic measurements, organ function (DENVER2 score), and biomarkers were recorded prospectively for the first 20d after burn injury.
RESULTS: Both cohorts were similar in demographic and injury characteristics. Patients in the PiCCO group received significantly less fluids (P<0.05) with similar urinary output, resulting in a significantly lower positive fluid balance (P<0.05). The central venous pressure in the PiCCO group was maintained in a more controlled range (P<0.05), associated with a significantly lower heart rate and significantly lower incidence of cardiac and renal failure (P<0.05).
CONCLUSIONS: Fluid resuscitation guided by transcardiopulmonary thermodilution during hospitalization represents an effective adjunct and is associated with beneficial effects on postburn morbidity.
Authors:
Robert Kraft; David N Herndon; Ludwik K Branski; Celeste C Finnerty; Katrina R Leonard; Marc G Jeschke
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-06-06
Journal Detail:
Title:  The Journal of surgical research     Volume:  181     ISSN:  1095-8673     ISO Abbreviation:  J. Surg. Res.     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-03-25     Completed Date:  2013-05-31     Revised Date:  2014-05-11    
Medline Journal Info:
Nlm Unique ID:  0376340     Medline TA:  J Surg Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  121-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Burns / physiopathology,  therapy*
Cardiac Output
Central Venous Pressure
Child
Female
Fluid Therapy*
Humans
Male
Thermodilution
Grant Support
ID/Acronym/Agency:
H133A020102//PHS HHS; H133A070026//PHS HHS; H133A70019//PHS HHS; KL2 RR029875/RR/NCRR NIH HHS; P50 GM060338/GM/NIGMS NIH HHS; P50 GM60338/GM/NIGMS NIH HHS; R01 GM056687/GM/NIGMS NIH HHS; R01 GM087285/GM/NIGMS NIH HHS; R01-GM56687/GM/NIGMS NIH HHS; T32 GM008256/GM/NIGMS NIH HHS; T32 GM008256/GM/NIGMS NIH HHS; UL1 RR029876/RR/NCRR NIH HHS; UL1 TR000071/TR/NCATS NIH HHS
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