Evaluation of the “Early” Use of Albumin in Children with Extensive Burns: A Randomized Controlled Trial*

Dittrich, Maria Helena Müller; Carvalho, Werther Brunow de; Lavado, Edson Lopes

doi:10.1097/pcc.0000000000000728

Cited by 44 publications

(23 citation statements)

References 32 publications

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“…Of the 777 titles and abstracts reviewed, 108 full-text articles were retained for further screening. Seven studies met the inclusion criteria (figure 1; n=359) 22–28…”

Section: Resultsmentioning

confidence: 99%

“…The seven studies that met the inclusion criteria were published between 1982 and 2016 (table 2). 22–28 Four studies were undertaken in the USA,22–24 28 with other studies carried out in Japan (n=1),27 Brazil (n=1)26 and China (n=1) 25. One randomised controlled trial,26 one cohort study,24 one prospective randomised study,23 two prospective observational studies25 28 and two retrospective observational studies22 27 were identified.…”

Section: Resultsmentioning

confidence: 99%

“…Due to the heterogeneity of study designs, methods used and endpoints monitored across the included studies, a narrative synthesis of the studies was performed. Study characteristics and results are shown in tables 2 and 3 22–28…”

Section: Methodsmentioning

confidence: 99%

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Fluid resuscitation in paediatric burns: how do we get it right? A systematic review of the evidence

2018

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BackgroundOptimal fluid resuscitation in children with major burns is crucial to prevent or minimise burn shock and prevent complications of over-resuscitation.ObjectivesTo identify studies using endpoints to guide fluid resuscitation in children with burns, review the range of reported endpoint targets and assess whether there is evidence that targeted endpoints impact on outcome.DesignSystematic review.MethodsMedline, Embase, Cinahl and the Cochrane Central Register of Controlled Trials databases were searched with no restrictions on study design or date. Search terms combined burns, fluid resuscitation, endpoints, goal-directed therapy and related synonyms. Studies reporting primary data regarding children with burns (<16 years) and targeting fluid resuscitation endpoints were included. Data were extracted using a proforma and the results were narratively reviewed.ResultsFollowing screening of 777 unique references, 7 studies fulfilled the inclusion criteria. Four studies were exclusively paediatric. Six studies used urine output (UO) as the primary endpoint. Of these, one set a minimum UO threshold, while the remainder targeted a range from 0.5–1.0 mL/kg/hour to 2–3 mL/kg/hour. No studies compared different UO targets. Heterogeneous study protocols and outcomes precluded comparison between the UO targets. One study targeted invasive haemodynamic variables, but this did not significantly affect patient outcome.ConclusionsFew studies have researched resuscitation endpoints for children with burns. Those that have done so have investigated heterogeneous endpoints and endpoint targets. There is a need for future randomised controlled trials to identify optimal endpoints with which to target fluid resuscitation in children with burns.

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“…Of the 777 titles and abstracts reviewed, 108 full-text articles were retained for further screening. Seven studies met the inclusion criteria (figure 1; n=359) 22–28…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Fluid resuscitation in paediatric burns: how do we get it right? A systematic review of the evidence

2018

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“…This study reported less crystalloid volume, but it has low sample size (n = 23) so that a larger study were needed in the future. 30 Melinyshyn et al 8 use albumin 5% in burn resuscitation, but did not demonstrate difference in duration of mechanical ventilation, wound healing, length of stay, nor survival rate. Albumin supplementation also has been proven to be not beneficial in a randomized controlled trial by Greenhalgh et al, while it increases the cost.…”

Section: Discussionmentioning

confidence: 96%

Association Between Serum Albumin And The Success Of Fluid Resuscitation In Children Hospitalizen In Cipto Mangunkusumo Hospital Burn Center

Dewi¹,

Kaltha²,

Wardhana³

et al. 2019

J Plast Rekons

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Background : Burn injury has a great impact on mortality and morbidity in children. Significant loss of albumin (hypoalbuminemia) in burn patient often leads to serious complications. However, it is still unclear whether serum albumin has a role in the success of fluid resuscitation in children with burn injury. Method : This is a retrospective cohort study based on medical record of children hospitalized with burn injury at Cipto Mangunkusumo Hospital Burn Centre from January 2012-March 2018. The subjects collected with the total sampling method. Result : Most burn injury happen because of scalds, and have grade 2 burn injury with PELOD score<10. Almost all subjects was succesfully resuscitated in the first 24 hour (95,1%). No association was found between the success of fluid resuscitation with either serum albumin [RR 1,175(95%CI 0,3-4,4) p=0,812], or with ureum, creatinin, lactate level, weight and the degree/extent of the burn injury. Conclusion: The success rate of fluid resuscitation in pediatric burn injury was quite high in Cipto Mangunkusumo Hospital Burn Centre. No association was found between serum albumin and the success of fluid resuscitation during the first 24 hour period. Keywords: albumin, burn, pediatric, resuscitation

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“…Other reviews of the use of albumin in burns and trauma resuscitation have confirmed the lack of untoward effects, but evidence of benefit has been harder to come by. [13][14][15][16][17][18][19] In the basic science literature, our understanding of the microcirculation and the mechanisms responsible for oedema formation are radically changing, centreing on the role of the glycocalyx. [20] That colloid osmotic pressure does not play the role it was assigned by Ernest Starling is known to many burn surgeons, as burn oedema usually resolves in the face of dropping albumin levels.…”

Section: Den Hollander Respondsmentioning

confidence: 99%

Hydroxyethyl starches in burns

Rogers

Hollander

2016

S Afr Med J

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Evaluation of the “Early” Use of Albumin in Children with Extensive Burns: A Randomized Controlled Trial*

Abstract: Early albumin infusion in children with burns greater than 15-45% total body surface area reduced the need for crystalloid fluid infusion during resuscitation. Significantly fewer cases of fluid creep and shorter hospital stay were also observed in this group of patients.

Cited by 44 publications

References 32 publications

Fluid resuscitation in paediatric burns: how do we get it right? A systematic review of the evidence

Fluid resuscitation in paediatric burns: how do we get it right? A systematic review of the evidence

Association Between Serum Albumin And The Success Of Fluid Resuscitation In Children Hospitalizen In Cipto Mangunkusumo Hospital Burn Center

Hydroxyethyl starches in burns

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