Enteral Resuscitation of Burn Shock Using World Health Organization Oral Rehydration Solution: A Potential Solution for Mass Casualty Care

Abstract

Enteral resuscitation could provide a means to resuscitate burn shock when intravenous (IV) therapy is unavailable, such as in mass disasters. We evaluated the extent of intestinal absorption and resuscitative effects of World Health Organization Oral Rehydration Solution after a 40% TBSA burn in anesthetized swine compared with the IV infusion of lactated Ringer's infused by Parkland formula. Plasma volume (PV) was measured using indocyanine green dye dilution. Intestinal absorption was assessed using phenol red as a nonabsorbable marker. Changes in hematocrit, hemodynamics, and measured PV showed equivalent resuscitative effects of enteral and IV resuscitation. The duodenal fluid absorption rate started at 77 +/- 32 ml/hr per meter of intestine during the first hour and increased to 296 +/- 40 ml/hr during the fourth hour of resuscitation, with a total of 93 +/- 2% of World Health Organization Oral Rehydration Solution infused into the intestine being absorbed. Intestinal absorption rates after burn injury are sufficient to resuscitate a 40% TBSA burn.

Gastric Emptying and Intestinal Transit of Various Enteral Feedings Following Severe Burn Injury

“…On the other hand, Vivonex, only with the aid of erythromycin, could further improve the plasma volume expansion. The remarkable finding that enteral resuscitation provides near equivalent volume expansion to IV fluids was reported in children with B20% TBSA burns using ORS [22], as well as in 40% TBSA in swine using ORS as intestinal or colonic infusions [10,23]. Our data suggests that despite the delay in intestinal transit, the resuscitating effects of ORS were not hindered, if given early after burn.…”

“…Enterally untreated rats did not receive any enteral feeding; they only underwent hematocrit assessment. Enterally treated rats received either one or multiple gavage doses of either: (1) a modified high salt World Health Organization (WHO) Oral Rehydration Solution ''ORS'' [10]; or (2) a caloric meal (Vivonex RTF Ò , Nestlé S.A., Vevey, Switzerland). Each group of rats (n = 9-10) was studied at different time points (1, 2, 4, and 6 h) after burn.…”

The Burns Fluid Grid. A Pre-Hospital Guide to Fluid Resuscitation in Burns

“…We have primarily considered the intravenous or intraosseous routes but in mass casualty situations the oral route may be the only feasible logistical possibility [15,16] and the concept of liberal oral fluids for all burns should be considered. Table 2).…”

The P50 Research Center in Perioperative Sciences

“…Optimization of resuscitation protocols revealed the importance of rapid initiation, the complications induced by delayed resuscitation, the perils of over- and under-resuscitation, the benefits of guided fluid administration, utility of enteral resuscitation (especially for mass disaster scenarios), and considerations for special populations (e.g. pediatrics, pregnancy) (2, 4–8). Characterization of the hyperdynamic phase occurring 2–3 days post-burn showed low systemic vascular resistance, elevated cardiac output, systolic dysfunction, and increased myocardial energy demand (5, 9).…”