Burn resuscitation with two doses of 4 mL/kg hypertonic saline dextran provides sustained fluid sparing: A 48-hour prospective study in conscious sheep

American College of Surgeons Advanced Trauma Life Support Chicago, IL: American College of Surgeons; Background: The large fluid volumes usually required for burn resuscitation can be suppressed for 8 to 12 hours by intravenous infusion of 4 mL · kg^-1 hypertonic saline dextran (HSD) 1 hour after burn. We hypothesized that a double (8 mL · kg^-1) dose of HSD or two repeated doses of 4 mL · kg^-1 could enhance or prolong the volume sparing. Methods: We produced a full-thickness flame burn covering 40% of the body surface on 18 anesthetized sheep. One hour after the burn, the animals were awake and resuscitated with either (1) lactated Ringer's solution (LR) only, (2) 8 mL · kg^-1 HSD followed by LR, or (3) 4 mL · kg^-1 HSD followed by LR, with a second dose of 4 mL · kg^-1 HSD administered when net fluid accumulation increased to 20 mL · kg^-1. For all regimens, infusion rates were adjusted to produce a urine output of 1 to 2 mL · kg^-1 · h^-1. Results: Animals resuscitated with only LR required fluid volumes identical to that predicted by the Parkland formula for the first 12 hours. Infusion of 8 mL · kg^-1 HSD initially created a net fluid loss (urine output > infused volume), followed by a rebound fluid requirement eventually equaling that of animals treated with LR only. Animals treated with two separate doses of 4 mL · kg^-1 HSD generally did not experience a net fluid loss or a rebound fluid requirement. Also in the HSDx2 group, peak and net fluid accumulation was less than that of the other two groups from 18 hours through 48 hours, although the difference was not significant. Conclusion: An initial 4 mL · kg^-1 dose of HSD reduces fluid requirements early after burn, and a second dose administered after an appropriate interval may prolong volume sparing through 48 hours. An 8 mL · kg^-1 continuously infused initial dose was without prolonged fluid sparing effect. The volume-sparing effect of HSD is thus dependent on all of the following: dose, dosing interval, and infusion rate.