Document Detail


Randomized trial of efficacy of crystalloid and colloid resuscitation on hemodynamic response and lung water following thermal injury.
MedLine Citation:
PMID:  6342554     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
To assess the effects of crystalloid and colloid resuscitation on hemodynamic response and on lung water following thermal injury, 79 patients were assigned randomly to receive lactated Ringer's solution or 2.5% albumin-lactated Ringer's solution. Crystalloid-treated patients required more fluid for successful resuscitation than did those receiving colloid solutions (3.81 vs. 2.98 ml/kg body weight/% body surface burn, p less than 0.01). In study phase 1 (29 patients), cardiac index and myocardial contractility (ejection fraction and mean rate of internal fiber shortening, Vcf) were determined by echocardiography during the first 48 hours postburn. Cardiac index was lower in the 12- to 24-hour postburn interval in the crystalloid group, but this difference between treatment groups had disappeared by 48 hours postburn. Ejection fractions were normal throughout the entire study, while Vcf was supranormal (p less than 0.01 vs. normals) and equal in the two resuscitation groups. In study phase 2 (50 patients), extravascular lung water and cardiac index were measured by a standard rebreathing technique at least daily for the first postburn week. Lung water remained unchanged in the crystalloid-treated patients (p greater than 0.10), but progressively increased in the colloid-treated patients over the seven day study (p less than 0.0001). The measured lung water in each treatment group was significantly different from one another (p less than 0.001). Cardiac index increased progressively and identically in both treatment groups over the study period (p less than 0.01). These data refute the existence of myocardial depression during postburn resuscitation and document hypercontractile left ventricular performance. The addition of colloid to crystalloid resuscitation fluids produces no long lasting benefit on total body blood flow, and promotes accumulation of lung water when edema fluid is being reabsorbed from the burn wound.
Authors:
C W Goodwin; J Dorethy; V Lam; B A Pruitt
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Annals of surgery     Volume:  197     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  1983 May 
Date Detail:
Created Date:  1983-06-17     Completed Date:  1983-06-17     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  520-31     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Albumins / therapeutic use
Body Water / physiology
Burns / physiopathology,  therapy*
Clinical Trials as Topic
Colloids
Echocardiography
Fluid Therapy
Heart / physiopathology
Hemodynamics*
Humans
Isotonic Solutions / therapeutic use*
Lung / physiopathology*
Middle Aged
Plasma Substitutes
Random Allocation
Chemical
Reg. No./Substance:
0/Albumins; 0/Colloids; 0/Isotonic Solutions; 0/Plasma Substitutes; 0/crystalloid solutions; 8022-63-7/Ringer's lactate
Comments/Corrections

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