Ihle J^1-2, Pacquola M¹, Harman E¹, McClure J^1-2,

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