A quantitative assessment of blood loss in burn wound excision and grafting

Steadman, Peter; Pegg, Shane

doi:10.1016/0305-4179(92)90182-t

Cited by 43 publications

(17 citation statements)

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“…13 In adults, estimates of blood loss have reached as high as 10% of a blood volume per %BSA excised and grafted. 14 Hence, a burn excision involving 20% TBSA in a child would result in a predicted blood loss of at least 40% of a blood volume. A head burn excision of 9% in a child would result in a loss of 40% of a blood volume.…”

mentioning

confidence: 99%

Prospective comparison of packed red blood cell–to–fresh frozen plasma transfusion ratio of 4

Palmieri

Greenhalgh

Sen

2013

Journal of Trauma and Acute Care Surgery

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confidence: 99%

Prospective comparison of packed red blood cell–to–fresh frozen plasma transfusion ratio of 4

Palmieri

Greenhalgh

Sen

2013

Journal of Trauma and Acute Care Surgery

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“…This observation was quantified by Mollison (1979), who noted that 1 unit (510 mL) of whole blood increases haemoglobin by 1-1.25 g/dL in a 70 kg individual. Using this and other values, formulae have been developed to quantify blood loss from variables recorded peri-operatively in a FBC (Steadman and Pegg, 1992;Budny et al, 1993;Brecher et al, 1997). One of the most cited formulae is that of Warden et al (1982) (Formula 1), which is given as follows: where RBCV is the red blood cell volume, (m) refers to male patient, (f) refers to female patient.…”

Section: Calculating Blood Lossmentioning

confidence: 99%

“…Once again blood volume is assumed to remain constant. The study used post-operative haemoglobin from a FBC taken 24 h post-operatively; assuming that by this time the patient will have been made haemodynamically stable (Steadman and Pegg, 1992). A formula that similarly uses the change in haemoglobin concentration was devised by Budny et al (1993), though this formula, rather than using Mollison's (1979) calculation, uses a formal estimation of blood volume (Formula 3).…”

Section: Calculating Blood Lossmentioning

confidence: 99%

“…By using 25-31 as an acceptable range they devised a formula for transfusing units of PRC that would result in an appropriate haematocrit in adults (Formula 7) (Criswell and Gamelli, 2005). Demographic/Formula Steadman and Pegg (1992) Blood loss (mL) = %TBSA to be excised Â 387 Blood loss (mL) = %TBSA to be excised Â 0.092 Â BV (mL) Budny et al Adults (1993) Blood loss (mL) = %TBSA to be excised Â 269 Blood loss (mL) = %TBSA to be excised Â 0.059 Â BV (mL) Children Blood loss (mL) = %TBSA to be excised Â 0.084 Â BV (mL) Brown et al Children (1995) Blood loss (mL) = %TBSA to be excised Â 2.43 Â weight(kg) Barret et al Children (1999) Blood loss (mL) = cm 2 to be excised Â 0.51 Hart et al Children (2001) Blood loss (mL) = cm 2 to be excised Â 0.53 tightening blood vessels to the skin and hence reducing the blood that could be lost there through surgery. Both pre-excisional subdermal injection of adrenaline by the tumescent technique and post-excisional compression of wounds with adrenaline soaked compresses have been examined (Barret et al, 1999;Robertson et al, 2001).…”

Section: Formulamentioning

confidence: 99%

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Burn surgery and blood loss – a review

Brazier

Sheena

Jeffery

2011

Trauma

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Objectives: Blood loss has long been recognised as a significant problem in burn surgery. Efforts have been made in the past to quantify this loss and determine what factors influence it the most. Several researchers have been able to produce and validate formulae that predict the volume of blood loss during excisional surgery. Accurately determining this allows appropriate volumes of blood to be ordered, reducing risk to patients and saving scarce resources. This article reviews the literature on blood loss in burns surgery, including influencing factors, methods of prediction and effective management. Methods: A literature review was conducted to examine methods used to measure, calculate and reduce blood loss in burn surgery. The validity of these methods and the limitations on accuracy will be discussed. Alternative methods shall also be considered. Results: Most current methods of estimating blood loss attempt to determine the volume of erythrocytes required to return haemoglobin concentrations to their pre-operative level. Various formulae have been developed to calculate this volume. Conclusions: Several authors have produced formulae that predict the volume of blood loss to a significant degree of accuracy. Different techniques have been shown to significantly reduce blood loss. In other areas of surgery, thromboelastometry has been used to identify the levels of specific blood component defects. The use of this method in burns surgery could, in the future, help develop a protocol for operative blood transfusion.

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“…[1][2][3][4] However, epinephrine tumescence of burn wounds and donor sites, combined with the use of topical epinephrine, has significantly reduced blood loss during burn surgery. [5][6][7][8][9] The acute systemic effects of the administered epinephrine (both subcutaneous and topical) are incompletely understood.…”

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confidence: 99%

What Are the Acute Cardiovascular Effects of Subcutaneous and Topical Epinephrine for Hemostasis During Burn Surgery?

Cartotto

Kadikar

Musgrave

et al. 2003

The Journal of Burn Care &Amp; Rehabilitation

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Although subcutaneous and topical epinephrine are widely used for hemostasis during burn surgery, the acute systemic cardiovascular effects of the epinephrine are neither well documented nor completely understood. The purpose of this work was to prospectively study the acute cardiovascular responses to epinephrine (epi) administered subcutaneously and topically during burn surgery. Consecutive patients who received subcutaneous and topical epi during burn surgery were monitored prior to the administration of epi, at 2-minute intervals during subcutaneous epi infiltration, and then after epi infiltration (during which time, topical epi was applied). This period of monitoring lasted up to 20 minutes and was referred to as an epinephrine event (EE). A total of 100 EEs from 38 operations in 24 patients (mean +/- SD: age 43 +/- 16 years, mean % TBSA burn 23 +/- 17%) were studied. The mean dose of subcutaneous epi was 30 +/- 30 microg/kg. Although all patients received topical epi, it was impossible to document the topical dose. There was no significant increase in heart rate from baseline, and no arrhythmias occurred. Mean arterial pressure (MAP) did acutely increase significantly by 17.0 +/- 14.1% from baseline (P =.009) and increased more than 10% from baseline in 64/100 EEs. However, the increase in MAP was independent of the dose of epi (r =.053). The increase in MAP was not clinically significant, did not require intervention, and did not appear to be related to the type of wound that received epi (donor site vs burn wound), or the depth of anesthesia, analgesia, or sedation. On the basis of these findings, the use of subcutaneous and topical epi appears to be safe and produces minimal acute cardiovascular effects.

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A quantitative assessment of blood loss in burn wound excision and grafting

Cited by 43 publications

References 1 publication

Prospective comparison of packed red blood cell–to–fresh frozen plasma transfusion ratio of 4

Prospective comparison of packed red blood cell–to–fresh frozen plasma transfusion ratio of 4

Burn surgery and blood loss – a review

What Are the Acute Cardiovascular Effects of Subcutaneous and Topical Epinephrine for Hemostasis During Burn Surgery?

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