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Resuscitation of Thermally Injured Patients with Oxygen Transport Criteria as Goals of Therapy

 

作者: Richard Barton,   Jeffrey Saffle,   Stephen Morris,   Mary Mone,   Byron Davis,   Jane Shelby,  

 

期刊: Journal of Burn Care & Rehabilitation  (OVID Available online 1997)
卷期: Volume 18, issue 1  

页码: 1-9

 

ISSN:0273-8481

 

年代: 1997

 

出版商: OVID

 

数据来源: OVID

 

摘要:

Resuscitation from shock based on oxygen transport criteria has been widely used in trauma and surgical patients, but has not been examined in thermally injured patients. To study the possible efficacy of this type of resuscitation, the oxygen transport characteristics of burn resuscitation were studied in nine adults, of whom six had inhalation injuries, with a mean burn size of 45% total body surface area and a mean age of 33.4 years, who were resuscitated based on oxygen transport criteria. Pulmonary artery balloon flotation catheters were placed and hemodynamic and oxygen transport parameters (Fick method) were measured hourly for 6 hours. Patients received fluid boluses in addition to resuscitation calculated by the Parkland formula, until the pulmonary artery wedge pressure reached 15 mm Hg, after which dobutaminc infusions (5 (μg/kg/min) were initiated. Cardiac index increased from 2.51 to 6.57 L/min/m2(p<0.05), whereas systemic vascular resistance fell from 1534 to 584 dyne sec/cms (p<0.05). Oxygen delivery (Do2I) and oxygen consumption (Vo2I) indexes increased significantly during the study period (573 ± 47 to 1028 ± 57, and 132 ± 8 to 172 ± 16 ml/min/m2, respectively; p<0.05). Vo2I appeared dependent on Do2I at levels of Do2I less than 800 ml/min/m2. In this study, depressed cardiovascular function in patients with burn injuries responded to volume loading and inotropic support much as it does in patients with shock of other etiologies. Whether oxygen transport-based resuscitation is effective in improving survival or the incidence of multiple organ failure is unknown and will need to be evaluated in randomized trials.

 

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