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