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Resuscitation, anaesthesia and analgesia of the burned patient

 

作者: Mette Berger,   Marc-André Bernath,   René Chioléro,  

 

期刊: Current Opinion in Anaesthesiology  (OVID Available online 2001)
卷期: Volume 14, issue 4  

页码: 431-435

 

ISSN:0952-7907

 

年代: 2001

 

出版商: OVID

 

数据来源: OVID

 

摘要:

Burns resuscitation has evolved over the past few decades towards more evidence-based management. It has been shown that patients with major burns (i.e. involving more than 30% of the body surface) benefit from invasive monitoring, and physiological variable targeted resuscitation using vasoactive agents for cardiovascular support. The invasive approach results in a reduction of mortality rates. Since the introduction of the Parkland formula in 1968, there has been a trend towards the administration of fluid resuscitation far in excess of the volume predicted with this formula. This has led to an increase in complication rates, with more pulmonary oedema, and the appearance of abdominal compartment syndrome. Hypertonic saline solutions, whether with dextran or not, have shown no advantage over the classic Ringer's lactate solution. The colloid controversy has reached burns resuscitation, with the demonstration that the liberal use of albumin is associated with higher mortality rates. Fresh frozen plasma should only be used for specific coagulation disorders. On the other hand, artificial colloids, particularly gelatines, remain a useful tool in patients with major burns and haemodynamic instability, particularly, and can be given as early as 6 h after injury. Considering the actual evidence, using inotropes and vasopressors to reach supranormal haemodynamic endpoints seems preferable to delivering unrestricted amounts of fluid.

 

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