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Effects of differing resuscitative fluids
Burns (1984), 10, 381-382
Printed in Great Britain
Abstracts CLINICAL STUDIES Healing of mixed depth burns Early excision and grafting of burns of indeterminant depth covering less than 20 per cent of the body surface is the preferred method of treatment since it resulted in an average shorter stay in hospital, lower costs and less time away from work than if the burned area was treated conservatively (no operation) and with the topical application of silver sulphadiazine. While early excision and grafting resulted in the increased use of blood products and operating facilities this did not induce increased patient morbidity. Long-term follow-up showed no difference in the need for reconstruction, incidence of blisters or loss of motion or contour irregularities although there was more mesh graft irregularity. The patients treated non-operatively required more late grafts for wound closure and showed more hypertrophic scarring. Engrav L. H., Heimbach D. M., Reus J. L. et al. (1983) Early excision and grafting vs, nonoperative treatment of burns of indeterminant depth: a randomized prospective study. J. Trauma 23, 1011.
Incidence of hypertrophic scars The factors associated with the development of hypertrophic scars were assessed in 100 patients during the 18 months following burns covering up to 20 per cent of the body surface area. Hypertrophic scars developed in 26 per cent of the 245 burned areas. There was no correlation between the development of wound problems and the age of the patient. Black skinned patients had more wound problems if the wound took more than 14 days to heal. In all patients hypertrophic scarring was most common in slowly healing wounds and least common when the wound was healed within 21 days of injury. Deitch E. A., Wheelahan T. M., Rose M. P. et al. (1983) Hypertrophic burn scars: analysis of variables. J. Trauma 23, 895.
Benefits of intensive colloid therapy When conventional crystalloid or very low concentration colloid therapy failed to induce effective resuscitation of severely burned patients, exchange therapy with type specific fresh frozen plasma was carried out and was found to be remarkably effective. The plasma exchange reduced the fluid requirements from a mean of 2.6 times
the predicted values to within the calculated requirements by 2.3 hours following plasma exchange and markedly improved the urine output and resolved the marked lactic acidosis. Warden G. D., Stratta R. J., Saflle J. R. et al. (1983) Plasma exchange therapy in patients failing to resuscitate from burn shock. J. Trauma 23, 945.
Use of 5 per cent Sulphamylon solutions The disadvantages of 10 per cent sulphamylon c r e a m - high osmolality leading to pain on application--can be reduced markedly by use of 5 per cent sulphamylon solution applied as soaked gauzes. The 5 per cent solution is equally effective in bacteriological terms using a burned rat model compared with the 10 per cent cream and better than silver sulphadiazine in attaining control of experimental burn wound infection, The 5 per cent solution provided prompt decreases in bacterial counts to less than 105 organisms per gram of tissue in most wounds by 48 hours of treatment. In addition the wounds did not show evidence of neoeschar formation. Murphy R. C., Kucan J. O., Robson M. C. et al. (1983) The effect of 5 per cent mafenide acetate solution on bacterial control in infected rat burns. J. Trauma 23, 878.
Effects of differing resuscitative fluids When burned children were resuscitated with either colloid or hypotonic or hypertonic crystalloid solutions, the hypertonic solution induced the greatest urine output of sodium as percentage of input and the colloid treated group showed the greatest loss of sodium when the exudate loss from the burn was added to the urine loss. In the colloid treated patients the sodium loss through the burn was more than five times the urine loss, The volume of fluid lost across the burned tissue was inversely related to the osmolality of the fluid used for resuscitation. Wound sodium loss was a function of both the sodium and the fluid load. Bowser B. H. and Caldwell F. T. (1983) The effects of resuscitation with hypertonic vs. hypotonic vs. colloid on wound and urine fluid and electrolyte losses in severely burned children. J. Trauma 23, 916.
Energy to nitrogen ratio and nitrogen balance Nitrogen balance was measured in 36 burned patients
Printed in Great Britain
Abstracts CLINICAL STUDIES Healing of mixed depth burns Early excision and grafting of burns of indeterminant depth covering less than 20 per cent of the body surface is the preferred method of treatment since it resulted in an average shorter stay in hospital, lower costs and less time away from work than if the burned area was treated conservatively (no operation) and with the topical application of silver sulphadiazine. While early excision and grafting resulted in the increased use of blood products and operating facilities this did not induce increased patient morbidity. Long-term follow-up showed no difference in the need for reconstruction, incidence of blisters or loss of motion or contour irregularities although there was more mesh graft irregularity. The patients treated non-operatively required more late grafts for wound closure and showed more hypertrophic scarring. Engrav L. H., Heimbach D. M., Reus J. L. et al. (1983) Early excision and grafting vs, nonoperative treatment of burns of indeterminant depth: a randomized prospective study. J. Trauma 23, 1011.
Incidence of hypertrophic scars The factors associated with the development of hypertrophic scars were assessed in 100 patients during the 18 months following burns covering up to 20 per cent of the body surface area. Hypertrophic scars developed in 26 per cent of the 245 burned areas. There was no correlation between the development of wound problems and the age of the patient. Black skinned patients had more wound problems if the wound took more than 14 days to heal. In all patients hypertrophic scarring was most common in slowly healing wounds and least common when the wound was healed within 21 days of injury. Deitch E. A., Wheelahan T. M., Rose M. P. et al. (1983) Hypertrophic burn scars: analysis of variables. J. Trauma 23, 895.
Benefits of intensive colloid therapy When conventional crystalloid or very low concentration colloid therapy failed to induce effective resuscitation of severely burned patients, exchange therapy with type specific fresh frozen plasma was carried out and was found to be remarkably effective. The plasma exchange reduced the fluid requirements from a mean of 2.6 times
the predicted values to within the calculated requirements by 2.3 hours following plasma exchange and markedly improved the urine output and resolved the marked lactic acidosis. Warden G. D., Stratta R. J., Saflle J. R. et al. (1983) Plasma exchange therapy in patients failing to resuscitate from burn shock. J. Trauma 23, 945.
Use of 5 per cent Sulphamylon solutions The disadvantages of 10 per cent sulphamylon c r e a m - high osmolality leading to pain on application--can be reduced markedly by use of 5 per cent sulphamylon solution applied as soaked gauzes. The 5 per cent solution is equally effective in bacteriological terms using a burned rat model compared with the 10 per cent cream and better than silver sulphadiazine in attaining control of experimental burn wound infection, The 5 per cent solution provided prompt decreases in bacterial counts to less than 105 organisms per gram of tissue in most wounds by 48 hours of treatment. In addition the wounds did not show evidence of neoeschar formation. Murphy R. C., Kucan J. O., Robson M. C. et al. (1983) The effect of 5 per cent mafenide acetate solution on bacterial control in infected rat burns. J. Trauma 23, 878.
Effects of differing resuscitative fluids When burned children were resuscitated with either colloid or hypotonic or hypertonic crystalloid solutions, the hypertonic solution induced the greatest urine output of sodium as percentage of input and the colloid treated group showed the greatest loss of sodium when the exudate loss from the burn was added to the urine loss. In the colloid treated patients the sodium loss through the burn was more than five times the urine loss, The volume of fluid lost across the burned tissue was inversely related to the osmolality of the fluid used for resuscitation. Wound sodium loss was a function of both the sodium and the fluid load. Bowser B. H. and Caldwell F. T. (1983) The effects of resuscitation with hypertonic vs. hypotonic vs. colloid on wound and urine fluid and electrolyte losses in severely burned children. J. Trauma 23, 916.
Energy to nitrogen ratio and nitrogen balance Nitrogen balance was measured in 36 burned patients