27 hours ago Patients who received albumin during resuscitation because of increased fluid requirements (ALB) were compared to a cohort of patients matched for age and TBSA who did not receive albumin (CON). Results: Patients with inhalation injury were significantly more likely to receive albumin (OR 4.89, 95% CI 2.58-9.30). ALB patients had significantly higher mean initial lactate … >> Go To The Portal
Albumin was protective in a multivariate model of mortality (OR 0.27, 95% CI 0.07-0.97). Conclusions: Despite more severe systemic dysfunction, burn patients who received albumin did not suffer increased mortality. A novel finding is the decreased likelihood of mortality associated with the administration of albumin during burn resuscitation.
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The meta-analysis suggests that, based on the totality of currently available evidence, acute burn shock resuscitation with albumin may reduce mortality and compartment syndrome. At the same time, the meta-analysis indicated important weaknesses in the existing evidence.
Randomized and nonrandomized controlled clinical studies evaluating mortality and morbidity in adult patients receiving albumin for burn shock resuscitation were identified by multiple methods, including computer database searches and examination of journal contents and reference lists.
The recent renewed interest in the use of albumin has been driven by the desire to reduce morbidity related to the large quantities of resuscitation fluid administered to burn patients in the first 24 hours.
Albumin infusion was accompanied by reduced odds of respiratory complications, renal dysfunction, need for escharotomy or fasciotomy, tissue necrosis, sepsis, cardiovascular complications, edema, hypoproteinemia, local infection, and gastrointestinal and central nervous system complications (Figures (Figures44and and5;5; Table Table3).3).
Animal studies demonstrate that during acute fluid resuscitation, administration of colloids, including albumin (ALB), have no ability to arrest the formation of burn wound edema, but they do reduce edema formation in the nonburn soft tissues and help preserve intravascular volume and reduce resuscitation fluid ...
Major burn patients lose a considerable amount of the intravascular albumin and become hypoalbuminemic. This hypoalbuminemic state may persist for weeks after the injury. Hypoalbuminemia is commonly seen in critically ill patients and has been demonstrated to be associated with poor clinical outcomes.
The best single indicator of adequate fluid resuscitation in major burn patients is hourly urine output. Once IV access is established, and fluids initiated, placement of a Foley catheter should take place in order to monitor urine output.
The IV fluids should be titrated 10-20% per hour in order to maintain a urine output of 30-50 mL/hr. For patients with burn injuries > 20% TBSA, the starting IV fluid rate is determined by the Consensus Formula which is 2ml/kg/%TBSA.
Burns produce hypermetabolic and hypercatabolic responses, which are related to the extent and depth of the injuries (9). Burns affecting >20% of the body surface cause a major loss of extracellular fluids, thereby inducing shock by increasing vascular permeability and reducing plasma albumin from the wound exudations.
Hypoalbuminemia results from direct losses of albumin from tissue damage, from compromised hepatic blood flow due to volume loss, and from inhibitory tissue factors (eg, tumor necrosis factor, interleukin-1, interleukin-6) released at the burn sites.
Indicators that a patient may need fluid resuscitation include: systolic BP <100mmHg; heart rate >90bpm; capillary refill >2s or peripheries cold to touch; respiratory rate >20 breaths per min; NEWS ≥5; 45o passive leg raising suggests fluid responsiveness.
Aim of fluid resuscitation Maintain circulatory volume in the face of losses due to the burn – this is essential for cardiac output, renal perfusion and tissue perfusion; Provide metabolic water; Maintain tissue perfusion to the zone of stasis and prevent the burn from deepening.
Burns are now commonly classified as superficial, superficial partial thickness, deep partial thickness and full thickness. A systematic approach to burn care focuses on the six “Cs”: clothing, cooling, cleaning, chemoprophylaxis, covering and comforting (i.e., pain relief).
In the hours immediately following a major burn injury, loss of capillary permeability allows intravascular fluid to flood into the extracellular space. During the emergent or resuscitative phase, efforts are directed at preventing or reversing burn shock using fluid replacement for- mulas.
Fluid resuscitation, regardless of solution type or estimated need, should be titrated to maintain a urine output of approximately 0.5–1.0 ml/kg/hour in adults and 1.0–1.5 ml/kg/hour in children.
Burn resuscitation refers to the replacement of fluids in burn patients to combat the hypovolemia and hypoperfusion that can result from the body's systemic response to burn injury.