Hypertonic saline dextran produces early (8-12 hrs) fluid sparing in burn resuscitation: A 24-hr prospective, double-blind study in sheep

Objective: Resuscitation of large bum injuries must quickly restore and maintain cardiovascular function and fluid balance while minimizing secondary edema-related damage. We tested the hypothesis that two 4-mL·kg^-1 doses of hypertonic saline dextran (HSD; 7.5% NaCl/6% dextran-70) can produce prolonged reduction in fluid requirements after burn injury. Design: Prospective, pseudo randomized, double-blind study. Setting: Animal research laboratory. Subjects: Female adult Merino sheep (n = 12). Interventions: Sheep were given a 40% total body surface area full-thickness flame burn under halothane anesthesia. One hour after the burn, the conscious animals received an initial dose of 4 mL·kg^-1 HSD (n = 6) or normal saline (NS; NaCl 0.9%) (n = 6) intravenously during 30 mins. This was followed by lactated Ringer's solution, infused to a target urine output of 1 mL·kg^{- 1}·hr^-1 throughout the 24-hr study. A second 4-mL·kg^-1 dose of HSD or NS was started at 12 hrs, and infused during 5 hrs. Measurements and Main Results: Hourly urine output measurements were used to guide the infusion rate of the lactated Ringer's. The initial infusion of HSD 1 hr after the burn injury promptly restored cardiac index, promoted diuresis, and reduced fluid requirements compared with the NS controls (73% reduction for HSD relative to NS at 8 hrs). Subsequent rebound fluid accumulation resulted in similar net fluid balances in both groups within 12 hrs after the burn. The second dose of HSD, given at 12 hrs, was without effect on hemodynamics and fluid balance. Conclusions: We conclude a considerable initial, but not sustained fluid-sparing effect of early HSD, and no effect of a late, slowly infused HSD dose in this two-dose regimen.