Randomized Trial of Efficacy of Crystalloid and Colloid Resuscitation on Hemodynamic Response and Lung Water Following Thermal Injury

Abstract

To assess the effects of crystalloid and colloid resuscitation on hemodynamic response and on lung water following thermal injury, 79 patients were assigned randomly to receive lactated Ringer's solution or 2.5% albumin-lactated Ringer's solution. Crystalloid-treated patients required more fluid for successful resuscitation than did those receiving colloid solutions (3.81 vs. 2.98 ml/kg body weight/% body surface burn, p less than 0.01). In study phase 1 (29 patients), cardiac index and myocardial contractility (ejection fraction and mean rate of internal fiber shortening, Vcf) were determined by echocardiography during the first 48 hours postburn. Cardiac index was lower in the 12- to 24-hour postburn interval in the crystalloid group, but this difference between treatment groups had disappeared by 48 hours postburn. Ejection fractions were normal throughout the entire study, while Vcf was supranormal (p less than 0.01 vs. normals) and equal in the two resuscitation groups. In study phase 2 (50 patients), extravascular lung water and cardiac index were measured by a standard rebreathing technique at least daily for the first postburn week. Lung water remained unchanged in the crystalloid-treated patients (p greater than 0.10), but progressively increased in the colloid-treated patients over the seven day study (p less than 0.0001). The measured lung water in each treatment group was significantly different from one another (p less than 0.001). Cardiac index increased progressively and identically in both treatment groups over the study period (p less than 0.01). These data refute the existence of myocardial depression during postburn resuscitation and document hypercontractile left ventricular performance. The addition of colloid to crystalloid resuscitation fluids produces no long lasting benefit on total body blood flow, and promotes accumulation of lung water when edema fluid is being reabsorbed from the burn wound.

Impact of carbon monoxide on cardiopulmonary dysfunction after smoke inhalation injury.

“…(Circulation Research 1990;66:69-75) T he inhalation of smoke is associated with severe pulmonary injury in fire victims.12 These same individuals also have depressed cardiovascular function since they require larger amounts of fluid for resuscitation to a normal circulatory status than patients with thermal injury alone. [3][4][5] We studied these conditions in an ovine model. The lung microvasculature was evaluated with a lung lymph fistula.…”

Fibrinogen metabolic responses to trauma

“…The effects of various crystalloids and colloids with different volume-expanding capacities have been reported in the literature [29][30][31][32][33]. Among these fluids, lactated Ringers solution (LR) is considered part of standard care [34].…”

Neonatal Infusion Therapy

“…Коллоидные растворы по ряду проведенных ис следований [7,8] не показали их явного клинического преимущества перед кристаллоидами при выведении больных из шока. Однако, все доступные нам в литера туре исследования и метаанализы [8][9][10][11], посвященные указанной проблеме, сравнивают действие на организм кристаллоидных и низкоконцентрированных коллоид ных препаратов (ГЭК и альбумин от 1 до 5%).…”

“…Однако, все доступные нам в литера туре исследования и метаанализы [8][9][10][11], посвященные указанной проблеме, сравнивают действие на организм кристаллоидных и низкоконцентрированных коллоид ных препаратов (ГЭК и альбумин от 1 до 5%).…”