Annals of Burns and Fire Disasters - vol. XIV - n. 2 - june 2001
Acute resuscitation of burn injury: haes-steril versus lactated ringer’s solution Al-Hawary s.E.,1 Abdel Razek e.M.,2 Belal t.H.,3 Mandoor e.2
1 Departments of Anaesthesia and Intensive Care, 2 Department of Plastic and Burns Surgery, 3 Department of Medical Biochemistry, Tanta Faculty of Medicine, Tanta, Egypt
SUMMARY. Thermal injuries cause many complications and deaths. Most burned patients have reduced plasma volume and expanded interstitial water. Haes-Steril is used for medium-term expansive volume replacement therapy to achieve a more rapid and profound improvement of haemodynamic variables. The current study compared the effects of acute fluid therapy using lactated Ringer’s solution and Haes-Steril 10% on haemodynamic variables, volume oxygen consumption, and renal function in burn patients. The study comprised 40 patients with burns greater than 15% of total body surface area allocated in two groups receiving either lactated Ringer’s solution or Haes-Steril 10%. Comparison of the results of the two groups studied showed a non-significant (p > 0.05) difference with regard to heart rate and mean arterial blood pressure but showed a significant (p <0.05) increase of central venous pressure, cardiac output, cardiac index, and VO2 in patients in the Haes group compared with the lactated Ringer’s group. Serum lactate and plasma endothelin-1 levels were decreased in both groups at the end of study period and were significantly correlated with increased cardiac index. Serum creatinine was significantly decreased, and the creatinine clearance rate was significantly increased in patients in the Haes group compared with those in the lactated Ringer’s group. We conclude that Haes-Steril 10% can improve the overall haemodynamic situation of burn patients and that serum creatinine can be used as a predictive factor for improvement.
Introduction
Burn shock is hypovolaemic and cellular in nature, and is characterized by specific haemodynamic changes, including decreased cardiac output, extracellular fluid and plasma volume, and oliguria. Multiple mediators have been proposed to explain the changes in vascular permeability. The mediators proposed produce an increase in vascular permeability or increased microvascular hydrostatic pressure. The end result is a disruption of the normal capillary barriers separating intravascular and interstitial compartments and rapid equilibrium between these compartments. Plasma volume is severely depleted, being clinically manifested as hypovolaemia, with a marked increase in extracellular fluid.
Proper fluid management is critical to survival in major thermal injury. The primary goal of fluid resuscitation is to replace fluid sequestrated as a result of thermal injury. The National Institutes of Health Consensus Summary on fluid resuscitation is not in agreement with regard to specific formulae, but there is a consensus on two major issues: general guidelines to be used during the resuscitation process, and the type of fluid.
Haes-Steril (hydroxyethyl starch) is a colloidal plasma volume substitute. Haes consists of D-glucose units linked via linear ·-1, 4-glycosidic bonds and branching off from about one every 17 glucose units via ·-1, 6-glycosidic bonds.3 Haes-Steril 10% is used for medium-term expansive volume replacement therapy in patient populations with hypovolaemia and shock in order to achieve a more rapid and more extensive expansion of plasma volume, with a more marked improvement of haemodynamic variables, microcirculatory flow, and oxygen delivery.
The purpose of the present study was to compare the effect of Haes-Steril 10% and lactated Ringer’s (LR) solution on haemodynamics, renal function, oxygen consumption, blood lactate and endothelin-1 as an inflammatory mediator released from the burned area.