Long Range Transport of War-Related Burn Casualties

Renz, Evan M.; Cancio, Leopoldo C.; Barillo, David J.; White, Christopher E.; Albrecht, Michael C.; Thompson, C. K.; Ennis, Jody L.; Wanek, Sandra M.; King, James A.; Chung, Kevin K.; Wolf, Steven E.; Holcomb, John B.

doi:10.1097/ta.0b013e31816086c9

Cited by 90 publications

(19 citation statements)

References 13 publications

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“…22 Colloid use has been associated with a lower incidence of abdominal compartment syndrome, including a protocol used by the Army during Operation Iraqi Freedom, which reduced the reported incidence of this complication to zero. 23,24 This parallels the experience we report here.…”

Section: Discussionsupporting

confidence: 92%

Colloid Administration Normalizes Resuscitation Ratio and Ameliorates “Fluid Creep”

Lawrence

Faraklas

Watkins

et al. 2010

Journal of Burn Care & Research

123

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Although colloid was a component of the original Parkland formula, it has been omitted from standard Parkland resuscitation for over 30 years. However, some burn centers use colloid as "rescue" therapy for patients who exhibit progressively increasing crystalloid requirements, a phenomenon termed "fluid creep." We reviewed our experience with this procedure. With Institutional Review Board approval, we reviewed all adult patients with > or =20%TBSA burns admitted from January 1, 2005, through December 31, 2007, who completed formal resuscitation. Patients were resuscitated using the Parkland formula, adjusted to maintain urine output of 30 to 50 ml/hr. Patients who required greater amounts of fluid than expected were given a combination of 5% albumin and lactated Ringer's until fluid requirements normalized. Results were expressed as an hourly ratio (I/O ratio) of fluid infusion (ml/kg/%TBSA/hr) to urine output (ml/kg/hr). Predicted values for this ratio vary for individual patients but are usually less than 0.5 to 1.0. Fifty-two patients were reviewed, of whom 26 completed resuscitation using crystalloid alone, and the remaining 26 required albumin supplementation (AR). The groups were comparable in age, gender, weight, mortality, and time between injury and admission. AR patients had larger total and full-thickness burns and more inhalation injuries. Patients managed with crystalloid alone maintained mean resuscitation ratios from 0.13 to 0.40, whereas AR patients demonstrated progressively increasing ratios to a maximum mean of 1.97, until albumin was started. Administration of albumin produced a dramatic and precipitous return of ratios to within predicted ranges throughout the remainder of resuscitation. No patient developed abdominal compartment syndrome. Measuring hourly I/O ratios is an effective means of expressing and tracking fluid requirements. The addition of colloid to Parkland resuscitation rapidly reduces hourly fluid requirements, restores normal resuscitation ratios, and ameliorates fluid creep. This practice can be applied selectively as needed using predetermined algorithms.

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Section: Discussionsupporting

confidence: 92%

Colloid Administration Normalizes Resuscitation Ratio and Ameliorates “Fluid Creep”

Lawrence

Faraklas

Watkins

et al. 2010

Journal of Burn Care & Research

123

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“…Because transportation time will be at least 3-4 days and patients are treated in 3-4 different medical facilities, the initial treatment of coalition casualties with burns focuses on emergency management and temporary, intermediate treatment due to the prolonged transportation time [4]. This treatment includes recognition of the need for escharotomy, fasciotomy, or laparotomy in cases of imminent compromised circulation by circular burns, compartment syndrome, abdominal hypertension, or abdominal compartment syndrome.…”

Section: Triagementioning

confidence: 99%

Incidence, Cause and Treatment of Burn Casualties Under War Circumstances

Breederveld

Tuinebreijer

2009

Eur J Trauma Emerg Surg

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Five to ten percent of all combat injuries in the last decade of armed conflicts have been burns. Here, the incidence, demographics, and treatment are different compared to civilian practice. The percentage of hand and facial burns is higher, the population of patients is healthier, there are more associated injuries, and the transportation time is longer. Due to the prolonged transportation time, emergency treatment and also intermediate treatment are important for a good outcome in patients with burns suffered in a military environment. Treatment guidelines and education of the involved medical personnel according to the findings described herein are important for better results in future combat casualties.

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“…About 1/3 of the patients required in flight ventilatory support, and about 1/3 of them were transported by CCATT. There were no inflight deaths [68].…”

Section: Aeromedical Evacuationmentioning

confidence: 99%