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Hemodynamic Changes During Resuscitation After Burns Using the Parkland Formula
Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Surgery UHL.
Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
Linköping University, Department of Computer and Information Science, Statistics. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
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2009 (English)In: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 66, no 2, 329-336 p.Article in journal (Refereed) Published
Abstract [en]

Background: The Parkland formula (2-4 mL/kg/burned area of total body surface area %) with urine output and mean arterial pressure (MAP) as endpoints; for the fluid resuscitation in burns is recommended all over the world. There has recently been a discussion on whether central circulatory endpoints should be used instead, and also whether volumes of fluid should be larger. Despite this, there are few central hemodynamic data available in the literature about the results when the formula is used correctly.

Methods: Ten burned patients, admitted to our unit early, and with a burned area of >20% of total body sur-face area were investigated at 12, 24, and 36 hours after injury. Using transesophageal echocardiography, pulmonary artery catheterization, and transpulmonary thermodilution to monitor them, we evaluated the cardiovascular coupling when urinary output and MAP were used as endpoints.

Results: Oxygen transport variables, heart rate, MAP, and left ventricular fractional area, did not change significantly during fluid resuscitation. Left ventricular end-systolic and end-diastolic area and global end-diastolic volume index increased from subnormal values at 12 hours to normal ranges at 24 hours after the burn. Extravascular lung intrathoracal blood volume ratio was increased 12 hours after the burn.

Conclusions: Preload variables, global systolic function, and oxygen transport recorded simultaneously by three separate methods showed no need to increase the total fluid volume within 36 hours of a major burn. Early (12 hours) signs of central circulatory hypovolemia, however, support more rapid infusion of fluid at the beginning of treatment.

Place, publisher, year, edition, pages
2009. Vol. 66, no 2, 329-336 p.
Keyword [en]
Cardiovascular coupling, Echocardiography, Hemodynamic monitoring, Fractional area change, Global end-diastolic volume
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-17146DOI: 10.1097/TA.0b013e318165c822OAI: diva2:202136
Available from: 2009-03-07 Created: 2009-03-07 Last updated: 2014-09-15
In thesis
1. Cardiovascular response to hyperoxemia, hemodilution and burns: a clinical and experimental study
Open this publication in new window or tab >>Cardiovascular response to hyperoxemia, hemodilution and burns: a clinical and experimental study
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The last decades less invasive monitoring and analytical tools have been developed for the evaluation of myocardial mechanics in clinical praxis. In critical care, these are longed-for complements to pulmonary artery catheter monitoring, additionally offering previously inaccessible information. This work is aimed, during fluid-replacement and oxygen therapy, to determine the physiological interface of ventricular and vascular mechanical properties, which result in the transfer of blood from the heart to appropriate circulatory beds. In prospective clinical studies we investigated previously cardiovascular healthy adults during hyperoxemia, and during preoperative acute normovolemic hemodilution or early fluid resuscitation of severe burn victims. Echocardiography was used in all studies, transthoracic for healthy volunteers and transesophageal for patients. For vascular parameters and for control purposes pulmonary artery Swan-Ganz catheter, calibrated external pulse recordings, whole body impedance cardiography, and transpulmonel thermodilution method were applied.

We detected no significant change in blood pressure or heart rate, the two most often used parameters for patient monitoring. During preoperative acute normovolemic hemodilution a reduction of hemoglobin to 80 g/l did not compromise systolic or diastolic myocardial function. Cardiac volumes and flow increased with a concomitant fall in systemic vascular resistance while oxygen delivery seemed maintained. Supplemental oxygen therapy resulted in a linear dose-response between arterial oxygen and cardiovascular parameters, suggesting a direct vascular effect. Cardiac flow decreased and vascular resistance increased from hyperoxemia, and a decrease of venous return implied extracardial blood-pooling. Severe burns result in hypovolemic shock if not properly treated. The commonly used Parkland fluid replacement strategy, with urinary output and mean arterial pressure as endpoints, has recently been questioned. Applying this strategy, only transient early central hypovolemia was recorded, while dimensional preload, global left ventricular systolic function and oxygen delivery or consumption remained within normal ranges during the first 36 hours after accident. Signs of restrictive left ventricular diastolic function were detected in all patients and regional unstable systolic dysfunction was recognized in every other patient, and was consistent with myocardial marker leakage. Severe burns thereby cause myocardial stiffness and systolic regional dysfunction, which may not be prevented only by central normovolemia and adequate oxygenation.

Place, publisher, year, edition, pages
Institutionen för medicinsk teknik, 2007
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1013
Anesthesia, general, Burns, Echocardiography, transesophageal, Hemodilution, emodynamic processes, Hyperoxia
National Category
Anesthesiology and Intensive Care
urn:nbn:se:liu:diva-10633 (URN)978-91-85831-11-1 (ISBN)
Public defence
2007-10-25, Elsa Brännströmssalen Universitetssjukhuset i Linköping, Campus US, Linköpings universitet, Linköping, 13:00 (English)
On the day of the defence date the status of article II was: In Press.Available from: 2008-01-28 Created: 2008-01-28 Last updated: 2009-08-22

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Bak, ZoltanSjöberg, FolkeEriksson, OlleSteinvall, IngridJanerot Sjöberg, Birgitta
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