Impact of Fluid Resuscitation Regimes in Relative Risk of Mortality in Burned Patients

Abstract

Background; Some studies have supported the opinion that patients who get greater volumes of resuscitation fluids are at a higher chance of edema, complications, and probably bad outcomes. In the results of the International Society of Burn Injuries approximately half (49.5%) added colloid before 24h. This study aims to analyze the relative risk for mortality comparing resuscitation in the first 24 hours with Parkland and resuscitation with the use of Colloids. Material and Methods; This was an observational prospective cohort study conducted in the Service of Burns of the University Hospital Centre "Mother Teresa" in Tirana (UHCT), Albania. The study includes adult patients with critical burns > 40% TBSA, hospitalized in the Intensive Care Unit of the service during the period 2014 to 2019. Resuscitation in the first 24 hours is done with Ringer Lactate according to Parkland and with Ringer Lactate with the addition of colloids after 12 hours. Results; The data for organ dysfunction and organ insufficiency were the same in the two groups without statistical significance. Mortality in the RL group was 48% (24 deaths of 50 patients) while in the RL + Colloid rehydrated group was 46% (23 deaths of 50 patients). Patients which have 40-60% burns and are rehydrated with RL + Colloids have a risk of death 0.4 times less than those rehydrated with RL. Conclusions; Resuscitation with Ringer lactate and Colloids in the first 24 hours of thermal damage is a rehydration alternative for the treatment of burn shock. This therapy especially helps patients with major burns > 40% TBSA who during rehydration require large amounts of fluids and are associated with severe plasma hypoalbuminemia. Number Need to Treat (NNT benefit) is 10 so 1 in 10 patients can benefit in lowering the risk of death with RL + Colloid rehydration.

Keywords

• Burns
• Mortality
• resuscitation fluids
• complications
• burn shock