| The impact of opioid administration on resuscitation volumes in thermally injured patients. | |
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MedLine Citation:
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PMID: 20061837 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Administration of resuscitation volumes far beyond the estimates established by burn-body weight resuscitation formulas has been well documented. The reasons behind this increase are not clear. We sought to determine if our resuscitation volumes had increased and, if so, what factors were related to their increase. A retrospective chart review identified 154 patients admitted with burns greater than 20% of their BSA during the years of 1975-1976 (period 1), 1990-1991 (period 2), and 2006-2007 (period 3). Charts were reviewed for total fluids (crystalloid, colloid, and blood products) and opioids given before admission, during the first 8 hours of treatment, the next 16 hours of treatment, and the following 24 hours of treatment. Opioids were converted to opioid equivalents (OE). Multiple regression analysis was performed to determine the effects of variables of interest and control for confounders. Significance was assumed at the P < .05 level. Resuscitation fluid volumes increased significantly among adults from 3.97 ml/kg/%BSA during the first period to 6.40 ml/kg/%BSA during the third period (P < .01). The same trend in children <30 kg was not seen (P = .72). Fluid administered during the first 24 hours was significantly associated with age, BSA, intubation, latter two study periods, and opioid administration. Fluid administration was consistently associated with opioid administration at all measured time points. At 24 hours postburn, patients who received 2 to 4 OE/kg required an average of additional 3,650 +/- 1,704 ml of fluid, those receiving 4 to 6 OE/kg had required an average of 25,154 +/- 4,386 ml, and those who received >6 OE kg had required an average of 32,969 +/- 3,982 ml. In this single center retrospective study, we have shown a statistically significant increase in resuscitation fluids (from 1975 to 2007) and an association of resuscitation volumes with opioids. Opioids have been shown to increase resuscitation volumes in critically ill patients through both central and peripheral effects on the cardiovascular system. Because increased fluid resuscitation has been associated with adverse consequences in other studies, further research on alternative pain control strategies in thermally injured patients is warranted. |
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Authors:
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Lucy Wibbenmeyer; Andy Sevier; Junlin Liao; Ingrid Williams; Timothy Light; Barbara Latenser; Robert Lewis; Patrick Kealey; Richard Rosenquist |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of burn care & research : official publication of the American Burn Association Volume: 31 ISSN: 1559-0488 ISO Abbreviation: J Burn Care Res Publication Date: 2010 Jan-Feb |
Date Detail:
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Created Date: 2010-01-11 Completed Date: 2010-05-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101262774 Medline TA: J Burn Care Res Country: United States |
Other Details:
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Languages: eng Pagination: 48-56 Citation Subset: IM |
Affiliation:
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Department of Surgery, The University of Iowa Carver College of Medicine, Iowa City, UT 52246, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Analgesics, Opioid / administration & dosage* Burns / complications, pathology, therapy* Child Cohort Studies Colloids Dose-Response Relationship, Drug Female Fluid Therapy* Humans Isotonic Solutions / administration & dosage* Male Middle Aged Pain / drug therapy*, etiology Plasma Substitutes / administration & dosage* Retrospective Studies Risk Factors Severity of Illness Index Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Analgesics, Opioid; 0/Colloids; 0/Isotonic Solutions; 0/Plasma Substitutes; 0/crystalloid solutions |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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