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Early fluid resuscitation with hyperoncotic hydroxyethyl starch 200/0.5 (10%) in severe burn injury
- Source :
- Critical Care
- Publication Year :
- 2010
- Publisher :
- Springer Science and Business Media LLC, 2010.
-
Abstract
- Introduction Despite large experience in the management of severe burn injury, there are still controversies regarding the best type of fluid resuscitation, especially during the first 24 hours after the trauma. Therefore, our study addressed the question whether hyperoncotic hydroxyethyl starch (HES) 200/0.5 (10%) administered in combination with crystalloids within the first 24 hours after injury is as effective as 'crystalloids only' in severe burn injury patients. Methods 30 consecutive patients were enrolled to this prospective interventional open label study and assigned either to a traditional 'crystalloids only' or to a 'HES 200/0.5 (10%)' volume resuscitation protocol. Total amount of fluid administration, complications such as pulmonary failure, abdominal compartment syndrome, sepsis, renal failure and overall mortality were assessed. Cox proportional hazard regression analysis was performed for binary outcomes and adjustment for potential confounders was done in the multivariate regression models. For continuous outcome parameters multiple linear regression analysis was used. Results Group differences between patients receiving crystalloids only or HES 200/0.5 (10%) were not statistically significant. However, a large effect towards increased overall mortality (adjusted hazard ratio 7.12; P = 0.16) in the HES 200/0.5 (10%) group as compared to the crystalloids only group (43.8% versus 14.3%) was present. Similarly, the incidence of renal failure was 25.0% in the HES 200/0.5 (10%) group versus 7.1% in the crystalloid only group (adjusted hazard ratio 6.16; P = 0.42). Conclusions This small study indicates that the application of hyperoncotic HES 200/0.5 (10%) within the first 24 hours after severe burn injury may be associated with fatal outcome and should therefore be used with caution. Trial registration NCT01120730.
- Subjects :
- Adult
Male
medicine.medical_specialty
Resuscitation
Abdominal compartment syndrome
Plasma Substitutes
Hydroxyethyl starch
Critical Care and Intensive Care Medicine
Hydroxyethyl Starch Derivatives
Sepsis
Humans
Medicine
Prospective Studies
Prospective cohort study
Aged
Hetastarch
Trauma Severity Indices
business.industry
Research
Incidence (epidemiology)
Hazard ratio
Crystalloid Solutions
Middle Aged
medicine.disease
Surgery
Treatment Outcome
Anesthesia
Fluid Therapy
Regression Analysis
Female
Isotonic Solutions
Burns
business
medicine.drug
Subjects
Details
- ISSN :
- 13648535
- Volume :
- 14
- Database :
- OpenAIRE
- Journal :
- Critical Care
- Accession number :
- edsair.doi.dedup.....ca11c36b166611e504d7718f3b7e7deb