Fl�ssigkeitstherapie und h�modynamisches Monitoring im Verbrennungsschock

Abstract

Successful surgical and intensive care treatment of severely burned patients requires adequate prehospital management and fluid resuscitation adjusted to individual needs of the patient. Burn shock fluid resuscitation is now predominantly performed utilizing crystalloid solutions. Whenever possible, colloid solutions should not be given in the first 24 h after burn injury. The rate of administration of resuscitation fluids should maintain urine outputs between 0.5 ml/kg per h and 1 ml/kg per h and mean arterial pressures of >70 mmHg. Extended hemodynamic monitoring can provide valuable additional information, if burn resuscitation is not proceeding as planned or volume therapy guided by these typical vital signs is not attaining the desired effect. We recommend this in patients with TBSA burns of >30%. Inhalation injuries, pre-existing cardiopulmonary diseases, or TBSA burns of >50% definitely require extended hemodynamic monitoring during burn shock resuscitation. The Swan-Ganz catheter or less invasive transcardiopulmonary indicator dilution methods can be utilized to assess hemodynamic data.

Peripheral venous pressure as a reliable predictor for monitoring central venous pressure in patients with burns

“…Hemodynamic monitoring has been shown to provide valuable additional information if burn resuscitation is not proceeding as planned or volume therapy guided by the typical vital signs is not attaining the desired effect. [ 4 5 ]…”