Burn resuscitation

Crystalloid versus colloid versus hypertonic saline hyperoncotic colloid in sheep

Somes C. Guha, Michael Kinsky, Brian Button, David Herndon, Lillian D. Traber, Daniel L. Traber, George Kramer

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Objectives: The present study was undertaken to assess the fluid balance and hemodynamic effects during the first 8 hrs of resuscitation in animals with a large body surface area burn, using lactated Ringer's solution, 6% hetastarch, and hypertonic saline dextran. Design: A prospective, blinded, controlled, terminal study, using anesthetized animals. The initial baseline period was followed by scald injury, and three different treatment regimens were administered from coded bags to achieve s physiologic end point. Setting: University laboratory. Subjects: Eighteen female sheep (35 to 45 kg) were anesthetized with isoflurane. Interventions: Test solutions (10 mL/kg of either lactated Ringer's solution, hetastarch, or hypertonic saline dextran) were infused 30 mins after the scald injury, at a rate to restore and maintain the baseline oxygen delivery (DO2) value. Measurements and Main Results: Cardiovascular hemodynamics, plasma sodium concentration, plasma colloid osmotic pressure, and fluid balance were measured before and after scalding and resuscitation. After the initial 10-mL/kg test solution dose was given, lactated Ringer's solution was infused to achieve the same end point of baseline DO2 for the remainder of the 8 hrs. The scald caused an initial 30% reduction in cardiac output, a 20% reduction in mean arterial pressure, and 10% to 15% increase in hematocrit. All three test solutions restored and maintained baseline DO2 within 1 hr. However, hetastarch and hypertonic saline dextran reduced the net fluid volume over 8 hrs by 48% and 74%, respectively, compared with lactated Ringer's solution. Edema in the burn wound was not affected by treatment, while hypertonic saline dextran reduced edema in nonburned skin compared with both lactated Ringer's solution and hypertonic saline dextran. Plasma colloid osmotic pressure was significantly higher in the herastarch and hypertonic saline dextran groups. A continuous decrease in plasma sodium concentrations from baseline values (149 to 145 mmol/L) was measured in the lactated Ringer's solution and hetastarch groups (130 to 133 mmol/L) over 8 hrs. Plasma sodium concentrations in the group receiving hypertonic saline dextran were increased (150 to 155 mmol/L) at 4 hrs, but returned toward baseline by 8 hrs. Conclusions: Net volume loading can be reduced markedly by initial resuscitation of large body surface area burn injury using a colloid (herastarch), and can be further reduced by use of hypertonic saline colloid. Hyponatremia was apparent in the isotonic crystalloid- and colloid-treated animals, but not in those animals treated with hypertonic saline colloid.

Original languageEnglish (US)
Pages (from-to)1849-1857
Number of pages9
JournalCritical Care Medicine
Volume24
Issue number11
DOIs
StatePublished - Nov 1996

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dextran - saline drug combination
Colloids
Resuscitation
Sheep
Hydroxyethyl Starch Derivatives
Water-Electrolyte Balance
Body Surface Area
Sodium
Osmotic Pressure
Wounds and Injuries
Edema
Hemodynamics
Hyponatremia
Isoflurane
crystalloid solutions
Hematocrit
Cardiac Output
Ringer's solution
Ringer's lactate
Arterial Pressure

Keywords

  • burn edema
  • burn resuscitation
  • colloid
  • crystalloid
  • dextran
  • hetastarch
  • hypertonic saline
  • hyponatremia
  • lactated Ringer's solution
  • oxygen delivery

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Burn resuscitation : Crystalloid versus colloid versus hypertonic saline hyperoncotic colloid in sheep. / Guha, Somes C.; Kinsky, Michael; Button, Brian; Herndon, David; Traber, Lillian D.; Traber, Daniel L.; Kramer, George.

In: Critical Care Medicine, Vol. 24, No. 11, 11.1996, p. 1849-1857.

Research output: Contribution to journalArticle

Guha, Somes C. ; Kinsky, Michael ; Button, Brian ; Herndon, David ; Traber, Lillian D. ; Traber, Daniel L. ; Kramer, George. / Burn resuscitation : Crystalloid versus colloid versus hypertonic saline hyperoncotic colloid in sheep. In: Critical Care Medicine. 1996 ; Vol. 24, No. 11. pp. 1849-1857.
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title = "Burn resuscitation: Crystalloid versus colloid versus hypertonic saline hyperoncotic colloid in sheep",
abstract = "Objectives: The present study was undertaken to assess the fluid balance and hemodynamic effects during the first 8 hrs of resuscitation in animals with a large body surface area burn, using lactated Ringer's solution, 6{\%} hetastarch, and hypertonic saline dextran. Design: A prospective, blinded, controlled, terminal study, using anesthetized animals. The initial baseline period was followed by scald injury, and three different treatment regimens were administered from coded bags to achieve s physiologic end point. Setting: University laboratory. Subjects: Eighteen female sheep (35 to 45 kg) were anesthetized with isoflurane. Interventions: Test solutions (10 mL/kg of either lactated Ringer's solution, hetastarch, or hypertonic saline dextran) were infused 30 mins after the scald injury, at a rate to restore and maintain the baseline oxygen delivery (DO2) value. Measurements and Main Results: Cardiovascular hemodynamics, plasma sodium concentration, plasma colloid osmotic pressure, and fluid balance were measured before and after scalding and resuscitation. After the initial 10-mL/kg test solution dose was given, lactated Ringer's solution was infused to achieve the same end point of baseline DO2 for the remainder of the 8 hrs. The scald caused an initial 30{\%} reduction in cardiac output, a 20{\%} reduction in mean arterial pressure, and 10{\%} to 15{\%} increase in hematocrit. All three test solutions restored and maintained baseline DO2 within 1 hr. However, hetastarch and hypertonic saline dextran reduced the net fluid volume over 8 hrs by 48{\%} and 74{\%}, respectively, compared with lactated Ringer's solution. Edema in the burn wound was not affected by treatment, while hypertonic saline dextran reduced edema in nonburned skin compared with both lactated Ringer's solution and hypertonic saline dextran. Plasma colloid osmotic pressure was significantly higher in the herastarch and hypertonic saline dextran groups. A continuous decrease in plasma sodium concentrations from baseline values (149 to 145 mmol/L) was measured in the lactated Ringer's solution and hetastarch groups (130 to 133 mmol/L) over 8 hrs. Plasma sodium concentrations in the group receiving hypertonic saline dextran were increased (150 to 155 mmol/L) at 4 hrs, but returned toward baseline by 8 hrs. Conclusions: Net volume loading can be reduced markedly by initial resuscitation of large body surface area burn injury using a colloid (herastarch), and can be further reduced by use of hypertonic saline colloid. Hyponatremia was apparent in the isotonic crystalloid- and colloid-treated animals, but not in those animals treated with hypertonic saline colloid.",
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T2 - Crystalloid versus colloid versus hypertonic saline hyperoncotic colloid in sheep

AU - Guha, Somes C.

AU - Kinsky, Michael

AU - Button, Brian

AU - Herndon, David

AU - Traber, Lillian D.

AU - Traber, Daniel L.

AU - Kramer, George

PY - 1996/11

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N2 - Objectives: The present study was undertaken to assess the fluid balance and hemodynamic effects during the first 8 hrs of resuscitation in animals with a large body surface area burn, using lactated Ringer's solution, 6% hetastarch, and hypertonic saline dextran. Design: A prospective, blinded, controlled, terminal study, using anesthetized animals. The initial baseline period was followed by scald injury, and three different treatment regimens were administered from coded bags to achieve s physiologic end point. Setting: University laboratory. Subjects: Eighteen female sheep (35 to 45 kg) were anesthetized with isoflurane. Interventions: Test solutions (10 mL/kg of either lactated Ringer's solution, hetastarch, or hypertonic saline dextran) were infused 30 mins after the scald injury, at a rate to restore and maintain the baseline oxygen delivery (DO2) value. Measurements and Main Results: Cardiovascular hemodynamics, plasma sodium concentration, plasma colloid osmotic pressure, and fluid balance were measured before and after scalding and resuscitation. After the initial 10-mL/kg test solution dose was given, lactated Ringer's solution was infused to achieve the same end point of baseline DO2 for the remainder of the 8 hrs. The scald caused an initial 30% reduction in cardiac output, a 20% reduction in mean arterial pressure, and 10% to 15% increase in hematocrit. All three test solutions restored and maintained baseline DO2 within 1 hr. However, hetastarch and hypertonic saline dextran reduced the net fluid volume over 8 hrs by 48% and 74%, respectively, compared with lactated Ringer's solution. Edema in the burn wound was not affected by treatment, while hypertonic saline dextran reduced edema in nonburned skin compared with both lactated Ringer's solution and hypertonic saline dextran. Plasma colloid osmotic pressure was significantly higher in the herastarch and hypertonic saline dextran groups. A continuous decrease in plasma sodium concentrations from baseline values (149 to 145 mmol/L) was measured in the lactated Ringer's solution and hetastarch groups (130 to 133 mmol/L) over 8 hrs. Plasma sodium concentrations in the group receiving hypertonic saline dextran were increased (150 to 155 mmol/L) at 4 hrs, but returned toward baseline by 8 hrs. Conclusions: Net volume loading can be reduced markedly by initial resuscitation of large body surface area burn injury using a colloid (herastarch), and can be further reduced by use of hypertonic saline colloid. Hyponatremia was apparent in the isotonic crystalloid- and colloid-treated animals, but not in those animals treated with hypertonic saline colloid.

AB - Objectives: The present study was undertaken to assess the fluid balance and hemodynamic effects during the first 8 hrs of resuscitation in animals with a large body surface area burn, using lactated Ringer's solution, 6% hetastarch, and hypertonic saline dextran. Design: A prospective, blinded, controlled, terminal study, using anesthetized animals. The initial baseline period was followed by scald injury, and three different treatment regimens were administered from coded bags to achieve s physiologic end point. Setting: University laboratory. Subjects: Eighteen female sheep (35 to 45 kg) were anesthetized with isoflurane. Interventions: Test solutions (10 mL/kg of either lactated Ringer's solution, hetastarch, or hypertonic saline dextran) were infused 30 mins after the scald injury, at a rate to restore and maintain the baseline oxygen delivery (DO2) value. Measurements and Main Results: Cardiovascular hemodynamics, plasma sodium concentration, plasma colloid osmotic pressure, and fluid balance were measured before and after scalding and resuscitation. After the initial 10-mL/kg test solution dose was given, lactated Ringer's solution was infused to achieve the same end point of baseline DO2 for the remainder of the 8 hrs. The scald caused an initial 30% reduction in cardiac output, a 20% reduction in mean arterial pressure, and 10% to 15% increase in hematocrit. All three test solutions restored and maintained baseline DO2 within 1 hr. However, hetastarch and hypertonic saline dextran reduced the net fluid volume over 8 hrs by 48% and 74%, respectively, compared with lactated Ringer's solution. Edema in the burn wound was not affected by treatment, while hypertonic saline dextran reduced edema in nonburned skin compared with both lactated Ringer's solution and hypertonic saline dextran. Plasma colloid osmotic pressure was significantly higher in the herastarch and hypertonic saline dextran groups. A continuous decrease in plasma sodium concentrations from baseline values (149 to 145 mmol/L) was measured in the lactated Ringer's solution and hetastarch groups (130 to 133 mmol/L) over 8 hrs. Plasma sodium concentrations in the group receiving hypertonic saline dextran were increased (150 to 155 mmol/L) at 4 hrs, but returned toward baseline by 8 hrs. Conclusions: Net volume loading can be reduced markedly by initial resuscitation of large body surface area burn injury using a colloid (herastarch), and can be further reduced by use of hypertonic saline colloid. Hyponatremia was apparent in the isotonic crystalloid- and colloid-treated animals, but not in those animals treated with hypertonic saline colloid.

KW - burn edema

KW - burn resuscitation

KW - colloid

KW - crystalloid

KW - dextran

KW - hetastarch

KW - hypertonic saline

KW - hyponatremia

KW - lactated Ringer's solution

KW - oxygen delivery

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