Effect of Hypertonic Fluid Resuscitation in Major Burn Injury

ABSTRACT

PURPOSE: There are some complications such as pulmonary edema, soft tissue swelling, decreased tissue perfusion which is frequently occurred in isotonic fluid resuscitation like Parkland formula. Hypertonic fluid resuscitation has several effects in burn patients. It may reduce soft tissue swelling and induce fluid shift from interstitium to vascular system. This study aims to compare actual fluid demand after hypertonic fluid resuscitation (160 mEq Na/L) and calculated volume from Parkland formula in severe burn patients. METHODS: From March 2010 to June 2011, a retrospective study was done. 21 patients were selected who had admitted within 6 hours after injury by various mechanisms. Total body surface area was calculated by Lund-Browder diagram. All subjects were treated by hypertonic fluid (Hartmann's solution +30 mEq NaHCo3, 160 mEq/L of Na+). After first 24 hr of resuscitation, physiologic parameters and total infused fluid volume was calculated. Physiologic parameters were used for assessing the effect of fluid therapy, and total infused fluid volume was compared to theoretical volume in Parkland formula, using dependent t-test. RESULTS: Mean TBSA of subjects was 47+/-5%, and four cases were accompanied by inhalation injury. The actual fluid volume infused was about 3.12 ml/kg/% and base excess was -0.5+/-2.8. Pulmonary edema was identified in 4 cases. CONCLUSION: Using hypertonic fluid (160 mEq Na/L), total fluid volume was reduced about 22% compared to Parkland formula without considerable complications.