A new fluid resuscitation protocol for severe burns with haemodynamic goal directed targets using pulse contour analysis

Ihle J1-2, Pacquola M1, Harman E1, McClure J1-2,

1 Intensive Care Unit, The Alfred Hospital, Melbourne, VIC, Australia, j.ihle@alfred.org.au
2 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia

Background

Fluid resuscitation in severe burns is difficult.  Modern technology has seen the development of non-invasive continuous cardiac output monitors to help guide preload responsiveness.  There use in severe burns has been limited.  We aimed to implement a new fluid resuscitation protocol, using haemodynamic goal directed targets, with the aid of a continuous cardiac output monitor, to help guide fluid resuscitation.

Methods

Between 2014 and 2015 we conducted a prospective, observational study at a quaternary burns referral centre in Melbourne, Victoria before-and-after a protocol change in fluid resuscitation. We collected fluid resuscitation and haemodynamic data on 20 consecutive major (> 20% TBSA) burns patient (10 before protocol change – fluid type predominantly hypertonic saline and concentrated albumin). Haemodynamic data was collected using Edwards’ Vigileo/EV-1000 in both protocols, and it was also used in the newer protocol to help guide resuscitation.

Results

Statistical analysis was done using t-test. Patients were matched in age (49 vs 51.2), % TBSA (40 vs 48.7) and weight (80 vs 82).  Within the first 24hrs, the use of a continuous cardiac output monitor resulted in, on average, clinically less total fluid resuscitation (17.01 vs 15.75L p=0.57), less volume when compared to Parkland predicted (3.51 vs -0.25L p=0.19) and significantly less sodium administered (2574 vs 1160mmol/L p<0.05).

Conclusion

Implementation of a new protocol with goal directed haemodynamic targets using pulse contour analysis in severe burns may lead to less fluid administration when compared to a set resuscitation rate over 24hrs.

Key Words

Burns resuscitation, continuous cardiac output monitor, pulse contour analysis

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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