Decreased fluid volume to reduce organ damage: A new approach to burn shock resuscitation? A preliminary study

Objective: To evaluate the impact of decreased fluid resuscitation on multipleorgan dysfunction after severe burns. This approach was referred to as "permissive hypovotaemia". Methods: Two cohorts of patients with burns > 20% BSA without associated injuries and admitted to ICU within 6h from the thermal injury were compared. Patients were matched for both age and burn severity. The multiple-organ dysfunction score (MODS) by Marshall was calculated for 10 days after ICU admission. Permissive hypovotaemia was administered by a haemodynamic-oriented approach throughout the first 24-h period. Haemodynamic variables, arterial blood lactates and net fluid balance were obtained throughout the first 48 h. Results: Twenty-four patients were enrolled: twelve of them received the Parkland Formula while twelve were resuscitated according to the permissive hypovolaemic approach. Permissive hypovolaemia allowed for Less volume infusion (3.2 +/- 0.7 ml/kg/% burn versus 4.6 +/- 0.3 mt/kg/% burn; P < 0.001), a reduced positive fluid balance (+7.5 +/- 5.4 l/day versus +12 +/- 4.7 l/day; P < 0.05) and significantly lesser MODS Score values (P= 0.003) than the Parkland Formula. Both haemodynamic variables and arterial blood Lactate levels were comparable between the patient cohorts throughout the resuscitation period. Conclusions: Permissive hypovolaemia seems safe and well tolerated by burn patients. Moreover, it seems effective in reducing multiple-organ dysfunction as induced by oedema fluid accumulation and inadequate O-2 tissue utilization. (c) 2006 Elsevier Ireland Ltd. All rights reserved.