[A clinical study on the effects of delayed rapid fluid resuscitation on the blood circulation during postburn shock stage].

OBJECTIVE: To explore the protocol for the quick correction of postburn shock in case of delayed resuscitation.

METHODS: Twenty burn patients inflicted with 40% or bigger TBSA burn, and who were in shock due to delayed admission to hospital, were enrolled in the study. The patients were treated by delayed rapid fluid resuscitation. The amount of infused fluid and urine output was observed. The indices of hemodynamics and oxygen metabolism, i.e. arterial blood pressure (BP), pulmonary arterial pressure (PAP), pulmonary arterial wedge pressure (PAWP), central venous pressure(CVP), cardiac output (CO), pulmonary vascular resistance (PVR), systemic vascular resistance (SVR), oxygen delivery (DO2), oxygen consumption (VO2), oxygen extraction (O2ext), lactic acid (LA) and base deficit (BD) were monitored at the shock stage(1 approximately 48 PBHs).

RESULTS: The amount of rapid fluid infusion within 2 hours after admission accounted for (38.8 +/- 6.1)% of the amount calculated with the formula (The Third Military Medical University burn shock fluid infusion formula) for the 1st 24 PBHs. When the amount of prehospital infusion was added, the amount would be (48.3 +/- 5.0)% of the amount for the 1st 24 PBHs. The real amount of the infusion for the 1st 24 PBHs was (31.4 +/- 14.3)% more than that of the formula amount, and the real infused fluid amount for the 2nd 24 PBHs was (3.2 +/- 7.2)% more than that of the formula amount. After rapid fluid infusion, there exhibited remarkable increase in urine output, CO and DO2 with evident decrease in SVR, LA and BD. Furthermore, PAWP, PAP and CVP remained within normal range even though PVR increased significantly after rapid fluid infusion.

CONCLUSION: In case of shock or compulsory delayed resuscitation, rapid fluid resuscitation during early postburn stage was beneficial with critical hemodynamic monitoring. The amount of delayed rapid fluid infusion was much increased than routine. Hemodynamic indices such as CO, PAP, PAWP and CVP were employed as the guidelines for delayed rapid resuscitation with reference to some clinical indices such as serum LA, blood gas analysis and urine output.