Skip to main content
SpringerLink
Log in

Advances in fluid therapy and the early care of the burn patient

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

The resuscitation and early care of the burn patient has been placed on a more sound physiologic basis as a result of recent studies of the pathologic effects of thermal injury and the clinical application of technological advances. Whichever resuscitation formula is employed, its application should be guided by the patient's response to treatment. The surgeon must preserve vital organ function while taking advantage of compensatory mechanisms to minimize the deleterious effects of both the injury and the therapy. Resuscitation using only balanced salt solution in the first 24 hours, and reserving colloid-containing fluids for the second 24 hours, is clinically effective in the vast majority of burn patients, but should be altered in terms of volume and composition to meet the particular needs of any given burn patient. Repeated planned monitoring of cardiopulmonary function and of the peripheral circulation is mandatory to achieve maximum survival of unburned tissue and to reduce mortality. Careful fluid management, including daily assessment of fluid balance, is required from the time of admission until the burn wound has healed or been grafted.

Résumé

Les recherches récentes sur la pathologie des brûlures et les progrès techniques ont amélioré la réanimation et le traitement précoce des brûlés. Il existe divers schémas de réanimation: quelle que soit la technique employée, dans la pratique il faut toujours se guider sur la réponse du patient à la thérapeutique. Le chirurgien doit préserver les fonctions vitales tout en profitant des mécanismes compensatoires pour réduire les effets nocifs du traumatisme aussi bien que du traitement. Dans la majorité des cas, la réanimation est efficace si elle utilise uniquement des solutions électrolytiques équilibrées pendant les premières 24 heures et si elle réserve les colloïdes pour le 2ème jour. Mais il faut savoir, selon les besoins particuliers de chaque patient, changer les volumes et la composition des liquides perfusés. Les fonctions cardiopulmonaires et la circulation périphérique doivent être surveillées en permanence pour assurer une viabilité optimale des tissus non brûlés et réduire la mortalité. Des bilans journaliers doivent contrôler l'équilibre hydrique, jusqu'au moment où les brûlures sont guéries ou greffées.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cited in Monafo W.W.: Treatment of Burns. St. Louis, Warren H. Green Inc., 1970, p. 23

    Google Scholar 

  2. Sneve, H.: The treatment of burns and skin grafting. J.A.M.A.XLV:1, 1905

    Google Scholar 

  3. Cope, O., Moore, F.D.: The redistribution of body water in the fluid therapy of the burned patient. Ann. Surg.726:1013 (footnote), 1947

    Google Scholar 

  4. Ibid., p. 1010

    Google Scholar 

  5. Evans, E.I., Purnell, O.J., Robinett, P.W., Batchelor, A., Martin, M.: Fluid and electrolyte requirements in severe burns. Ann. Surg.735:804, 1952

    Google Scholar 

  6. Reiss, E., Stirman, J.A., Artz, C.P., Davis, J.H., Amspacher, W.H.: Fluid and electrolyte balance in burns. J.A.M.A.152:1309, 1953

    Google Scholar 

  7. Baxter, C.R., Shires, G.T.: Physiologic response to crystalloid resuscitation of severe burns. Ann. N.Y. Acad. Sci.150:874, 1968

    PubMed  Google Scholar 

  8. Monafo, W.W.: The treatment of burn shock by the intravenous and oral administration of hyperlonic lactated saline solution. J. Trauma10:575, 1970

    PubMed  Google Scholar 

  9. Arturson, G.: Pathophysiologic aspects of the burn syndrome with special reference to liver injury and alterations of capillary permeability. Acta Chir. Scand. [Suppl.]274:1, 1961

    Google Scholar 

  10. Shea, C.M., Caulfield, J.B., Burke, J.F.: Microvascular ultrastructure in thermal injury: a reconsideration of the role of mediators. Microvasc. Res.5:87, 1973

    PubMed  Google Scholar 

  11. Arturson, G., Mellander, S.: Acute changes in capillary filtration and diffusion in experimental burn injury. Acta Physiol. Scand.62:457, 1964

    PubMed  Google Scholar 

  12. Arturson, G., Soeda, S.: Changes in transcapillary leakage during healing of experimental burns. Acta Chir. Scand.133:609, 1967

    PubMed  Google Scholar 

  13. Curreri, P.W., Wilterdinck, M.E., Baxter, C.R.: Characterization of elevated fibrin split products following thermal injury. Ann. Surg.181:157, 1975

    PubMed  Google Scholar 

  14. Curreri, P.W., Wilterdinck, M.E., Baxter, C.R.: Coagulation dynamics following thermal injury, effect of heparin and protamine sulfate. Ann. Surg.181:161, 1975

    PubMed  Google Scholar 

  15. Luterman, A., Manwering, D., Curreri, P.W.: The role of fibrin degradation products in pathogenesis of the respiratory distress syndrome. Surgery(in press)

  16. Pruitt, B.A., Jr., Mason, A.D., Jr., Moncrief, J.A.: Hemodynamic changes in the early postburn patient: the influence of fluid administration and of a vasodilator (hydralazine). J. Trauma11:36, 1971

    PubMed  Google Scholar 

  17. Pruitt, B.A., Jr., Mason, A.D., Jr.: Hemodynamic studies of burned patients during resuscitation. In Research in Burns, Matter, P., Barclay, T.L., Konickova, Z., editors. Bern, Hans Huber Publishers, 1971, pp. 83–87

    Google Scholar 

  18. Baxter, C.R.: Fluid volume and electrolyte changes in the early postburn period. Clin. Plast. Surg.1:693, 1974

    PubMed  Google Scholar 

  19. Asch, M.J., Meserol, P.M., Mason, A.D., Jr., Pruitt, B.A., Jr.: Regional blood flow in the burned unanesthetized dog. Surg. Forum22:55, 1971

    PubMed  Google Scholar 

  20. O'Neill, J.A., Jr., Pruitt, B.A., Jr., Moncrief, J.A.: Studies of renal function during the early postburn period. In Research in Burns, Matter, P., Barclay, T.L., Konickova, Z., editors. Bern, Hans Huber Publishers, 1971, pp. 95–99

    Google Scholar 

  21. Asch, M.J., Feldman, R.J., Walter, H.L., Foley, F.D., Popp, R.L., Mason, A.D., Jr., Pruitt, B.A., Jr.: Systemic and pulmonary hemodynamic changes accompanying thermal injury. Ann. Surg.178:218, 1973

    PubMed  Google Scholar 

  22. Pruitt, B.A., Jr., Mason, A.D., Jr., Hunt, J.L.: Burn injury in the aged or high-risk patient. In The Aged and High-Risk Surgical Patient, Seigel, J.H., Chodoff, P.D., editors. New York, Grune & Stratton, Inc., 1976, pp. 523–526

    Google Scholar 

  23. Moylan, J.A., Jr., Reckler, J.M., Mason A.D., Jr.: Resuscitation with hypertonic lactate saline in thermal injury. Am. J. Surg.125:580, 1973

    PubMed  Google Scholar 

  24. Moylan, J.A., Jr., Reckler, J.M., Mason, A.D., Jr.: Hypertonic lactate saline resuscitation and thermal injury. Surg. Forum22:49, 1971

    PubMed  Google Scholar 

  25. Monafo, W.W., Chomchark, C., Ayvazian, V.H.: Hypertonic sodium solutions in the treatment of burn shock. Am. J. Surg.126:778, 1973

    PubMed  Google Scholar 

  26. Shimazaki, S., Yoshioka, T., Tanaka, N., Sugimoto, T., Ongi, Y.: Body fluid changes during hypertonic lactated saline solution therapy for burn shock. J. Trauma17:38, 1977

    PubMed  Google Scholar 

  27. Bane, J.W., McCaa, R.E., McCaa, C.S., Read, V.S., Turney, W.H., Turner, W.D.: The pattern of aldosterone and cortisole blood levels in thermal burn patients. J. Trauma14:605, 1974

    PubMed  Google Scholar 

  28. Moylan, J.A., Mason, A.D., Jr., Rogers, P.W., Walker, H.L.: Postburn shock: a critical evaluation of resuscitation. J. Trauma13:354, 1973

    PubMed  Google Scholar 

  29. McManus, W.F., Hunt, J.L., Pruitt, B.A., Jr.: Postburn convulsive disorders in children. J. Trauma14:396, 1974

    PubMed  Google Scholar 

  30. Evans, A.J.: The treatment of burn shock. In Pharmacological Treatment in Burns, Bertelli, A., Donati, L., editors. Amsterdam, Excerpta Medica Foundation, 1969, pp. 53–58

    Google Scholar 

  31. Atik, M.: Dextrans, their use in surgery and medicine. Anesthesiology27:425, 1966

    PubMed  Google Scholar 

  32. Saliba, M.J., Jr., Saliba, R.J.: Heparin in burns. Thromb. Diath. Hemorrh.33:113, 1975

    Google Scholar 

  33. Wells, C.H., Hilton, J.G., Larson, D.L., Sloan, D.F.: Effects of nicotinic acid upon postburn oedema: a preliminary report of clinical trials. Burns2:152, 1976

    Google Scholar 

  34. Larson, D.L.: On possible dangers of nicotinic acid therapy in acute burns. Plast. Reconstr. Surg.59:114, 1977

    PubMed  Google Scholar 

  35. Baxter, C.R., Moncrief, J.A., Prager, M.D., Cohen, L.S.: A circulating myocardial depressant factor in burn shock. In Research in Burns, Matter, P., Barclay, T.L., Konickova, Z., editors. Bern, Hans Huber Publishers, 1971, pp. 499–502

    Google Scholar 

  36. Baxter, C.R., Cook, W.A., Shires, J.T.: Serum myocardial depressant factor of burn shock. Surg. Forum17:1, 1966

    PubMed  Google Scholar 

  37. Gump, F.E., Kinney, J.M.: Energy balance and weight loss in burned patients. Arch. Surg.103:442, 1971

    PubMed  Google Scholar 

  38. Warden, G.D., Wilmore, D.W., Rogers, P.W., Mason, A.D., Jr., Pruitt, B.A., Jr.: Hypernatremic state in hypermetabolic burn patients. Arch. Surg.106:420, 1973

    PubMed  Google Scholar 

  39. Pruitt, B.A., Jr., Bowling, J.A., Moncrief, J.A.: Escharotomy in early burn care. Arch. Surg.96:502, 1968

    PubMed  Google Scholar 

  40. Moylan, J.A., Inge, W.W., Jr., Pruitt, B.A., Jr.: Circulatory changes following circumferential extremity burns. Evaluated by the ultrasonic flowmeter: an analysis of 60 thermally injured limbs. J. Trauma11:763, 1971

    PubMed  Google Scholar 

  41. Asch, M.J., Flemma, R.J., Pruitt, B.A., Jr.: Ischemic necrosis of tibialis anterior muscle in burn patients: report of 3 cases. Surgery66:846, 1969

    PubMed  Google Scholar 

  42. DiVincenti, F.C., Moncrief, J.A., Pruitt, B.A., Jr.: Electrical injuries: a review of 65 cases. J. Trauma9:497, 1969

    PubMed  Google Scholar 

  43. Hunt, J.L., McManus, W.F., Haney, W.P., Pruitt, B.A., Jr.: Vascular lesions in acute electric injuries. J. Trauma14:461, 1974

    PubMed  Google Scholar 

  44. Salisbury, R.E., McKeel, D.W., Mason, A.D., Jr.: Ischemic necrosis of the intrinsic muscles of the hand after thermal injury. J. Bone Joint Surg. [Am.]54:1701, 1974

    Google Scholar 

  45. Pontén, B., Erikson, V., Johnsson, S.H., Olding, L.: New observations on tissue changes along the pathway of the current in an electrical injury. Scand. J. Plast. Reconstr. Surg.4:75, 1970

    PubMed  Google Scholar 

  46. Clayton, J.M., Russel, H.E., Hartford, E.E., Boyd, W.C., Barnes, R.W.: Sequential circulatory changes in the circumferentially burned limb. Ann. Surg.185:391, 1977

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Brooke Army Medical Center, United States Army Institute of Surgical Research, 78234, Fort Sam Houston, Texas, USA

    Basil A. Pruitt Jr. M.D., F.A.C.S. (Colonel, MC, Commander and Director)

Authors
  1. Basil A. Pruitt Jr. M.D., F.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pruitt, B.A. Advances in fluid therapy and the early care of the burn patient. World J. Surg. 2, 139–148 (1978). https://doi.org/10.1007/BF01553536

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01553536

Keywords

Search

Navigation