Intrathoracic Blood Volume as an End Point in Resuscitation of the Severely Burned: An Observational Study of 24 Patients

Holm, Charlotte; Melcer, B.; Hörbrand, F.; Wörl, H.; Donnersmarck, G. Henckel von; Mühlbauer, W.

doi:10.1097/00005373-200004000-00023

Cited by 100 publications

(42 citation statements)

References 12 publications

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“…Fluid accumulates more readily in children, in comparison to adults, due to less compliant heart muscle and increased capillary permeability in immediate post burn period [22]. Oedema forming as a consequence of fluid overresuscitation increases the likelihood of organ dysfunction and with increasing volumes of fluid administered the risk of pneumonia, sepsis, Acute Respiratory Distress Syndrome (ARDS), Multi-organ failure and death increases [13].…”

Section: Discussionmentioning

confidence: 99%

Lack of a standardised UK care pathway resulting in national variations in management and outcomes of paediatric small area scalds

Trevatt

Kirkham

Allix

et al. 2016

Burns

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. A reduced fluid regime has significantly shortened LOS/%BSA without compromising burn depth. A prospective randomised control trial comparing permissive hypovolaemia resuscitation to current recommended regimes for moderate paediatric scald injuries would help clarify.

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Section: Discussionmentioning

confidence: 99%

Lack of a standardised UK care pathway resulting in national variations in management and outcomes of paediatric small area scalds

Trevatt

Kirkham

Allix

et al. 2016

Burns

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“…17 Recently, we reported on the use of ICG for invasive monitoring and guidance of fluid therapy of severely burned patients during the resuscitation period. 18,19 After intravenous injection, ICG completely binds to plasma proteins and is exclusively distributed in the intravascular space. 20 This makes it a suitable tracer for vessel perfusion.…”

Section: Indocyanine Greenmentioning

confidence: 99%

Monitoring free flaps using laser‐induced fluorescence of indocyanine green: A preliminary experience

et al. 2002

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In a prospective, clinical study, the clinical utility of indocyanine green for intraoperative monitoring of free tissue transfer was evaluated. The study comprised 20 surgical patients undergoing elective microsurgical procedures. Indocyanine green angiography was performed intraoperatively, immediately after flap inset, and the operating team was blind to the fluoremetric findings. Thereafter, postoperative monitoring was done exclusively by clinical examination (color, temperature, time for recapillarization, and bleeding after puncture). Final outcome was compared with results of perioperative indocyanine (ICG)-imaging, and classified either as total flap loss, partial flap loss, or successful tissue transplantation. A total of 2 (10%) complications was recorded, and included one partial and one total flap loss. Both complications were detected by intraoperative ICG imaging. Another case of intraoperative subclinical arterial spasm at the place of microvascular anastomosis was revealed by dynamic ICG-videography. This flap did not develop postoperative complications. In conclusion, evaluation of perfusion by ICG imaging is feasible in all kinds of microsurgical flaps, irrespective of the type of tissue. Even though not meeting all the criteria of an ideal monitoring device, significant additional information can be obtained. In this study, cases with arterial spasm, venous congestion, and regional hypoperfusion were revealed by intraoperative ICG-videography. There was a strong correlation between intraoperative findings and clinical outcome.

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“…Der Swan-Ganz-Katheter wird über eine großlumige zentralvenöse Schleuse eingeführt, die bei ohnehin erhöhter Gefahr einer Sepsis bei Brandverletzten einen zusätzlichen potenziellen Fokus darstellt. In kürzlich publizierten Arbeiten, wurden weniger invasive Methoden zum hämodynamischen Monitoring Brandverletzter eingesetzt [18,19,12,13]. Diese beruhen auf einer transkardiopulmonalen Einzel (Kälte)-oder Doppelindikatorverdünnung (Kälte plus Farbstoff).…”

Section: Transkardiopulmonale Indikatordilutionunclassified

“…abgeschätzt (PiCCO ® -System) werden. In wieweit das ITBV als Zielparameter in der Flüssigkeitstherapie Schwerverbrannter [13] und das EVLW als Parameter der kapillären Schrankenstörung in der Lunge nach IHT oder als Sepsisindikator [15] einen Einfluss auf das "Outcome" der Patienten haben, müssen weitere Studien zeigen. Zudem zeigte eine kürzlich veröffent-lichte Studie, dass die Schätzungen des ITBV und EVLW durch reine Thermodilution ungenaue Werte liefern und somit nicht zur Steuerung der Flüssigkeitsthe-rapie im Verbrennungsschock herangezogen werden sollten [19].…”

Section: Transkardiopulmonale Indikatordilutionunclassified

“…Zudem zeigte eine kürzlich veröffent-lichte Studie, dass die Schätzungen des ITBV und EVLW durch reine Thermodilution ungenaue Werte liefern und somit nicht zur Steuerung der Flüssigkeitsthe-rapie im Verbrennungsschock herangezogen werden sollten [19]. Systeme, die das ITBV und EVLW exakt messen [13,19] sind derzeit nicht mehr kommerziell erhältlich.…”

Section: Transkardiopulmonale Indikatordilutionunclassified

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Fl�ssigkeitstherapie und h�modynamisches Monitoring im Verbrennungsschock

Czermak

Hartmann

Scheele

et al. 2004

Chirurg

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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.

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Intrathoracic Blood Volume as an End Point in Resuscitation of the Severely Burned: An Observational Study of 24 Patients

Cited by 100 publications

References 12 publications

Lack of a standardised UK care pathway resulting in national variations in management and outcomes of paediatric small area scalds

Lack of a standardised UK care pathway resulting in national variations in management and outcomes of paediatric small area scalds

Monitoring free flaps using laser‐induced fluorescence of indocyanine green: A preliminary experience

Fl�ssigkeitstherapie und h�modynamisches Monitoring im Verbrennungsschock

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