Burn Shock and Resuscitation

Abstract

The Special Interest Groups of the American Burn Association provide a forum for interested members of the multidisciplinary burn team to congregate and discuss matters of mutual interest. At the 47th Annual Meeting of the American Burn Association in Chicago, IL, the Fluid Resuscitation Special Interest Group sponsored a special symposium on burn resuscitation. The purpose of the symposium was to review the history, current status, and future direction of fluid resuscitation of patients with burn shock. The reader will note several themes running through the following presentations. One is the perennial question of the proper role for albumin or other fluid-sparing strategies. Another is the unique characteristics of the pediatric burn patient. A third is the need for multicenter trials of burn resuscitation, while recognizing the obstacles to conducting randomized controlled trials in this setting.

Burn injury

“…Adequate resuscitation in patients with burn injury is challenging because questions abound regarding volume, composition, formulae and outcome measurement. An emerging technology is the 'burn navigator' , which determines resuscitation parameters from urinary output data as a closed loop -adjusting fluid infusion volume automatically based on prior algorithms 243,244 . This technology certainly has potential given that organ function such as cardiac function, and liver and kidney perfusion can be integrated, but it does require optimization.…”

Scarring After Burn Injury

“…At 20% TBSA, intravenous fluid resuscitation is routinely initiated, and the effect of the burn inflammatory response ceases to be localised to the burn area and has systemic consequences. The resultant fluid shifts and loss from the circulation are thus markedly more significant and, if untreated, result in burn shock with cardiac and renal consequences [20,21]. At 50% TBSA, the burn area usually exceeds the available donor site area (since we do not harvest grafts from the unburned face, neck, palms of hands or soles of feet).…”

Burn Injury-Associated MHCII+ Immune Cell Accumulation Around Lymphatic Vessels of the Mesentery and Increased Lymphatic Endothelial Permeability Are Blocked by Doxycycline Treatment

“…According to the American Burn Association, almost 500,000 Americans sustained significant burns in 2016. [13][14][15] The mortality rate following burn (including all forms of burn) is 3.3%, whereas those burned by fire or flames have a higher mortality rate of 5.8%. 14,15 The risk of death associated with burn increases with the size of the burn sustained (% of surface area).…”