Colloid Administration Normalizes Resuscitation Ratio and Ameliorates “Fluid Creep”

• DOI: 10.1097/bcr.0b013e3181cb8c72
• Publication Date: 2010-01-05T08:21:37Z
• Authors: Amanda Lawrence; Iris Faraklas; Holly Watkins; Ashlee Allen; Amalia Cochran; Stephen Morris; Jeffrey Saffle
• Keywords: Adult; Male; Adolescent; Plasma Substitutes; Crystalloid Solutions; Middle Aged; 3. Good health; Cohort Studies; Young Adult; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Fluid Therapy; Humans; Female; Colloids; Isotonic Solutions; Burns; Infusions, Intravenous; Algorithms; Serum Albumin; Aged; Retrospective Studies

Although colloid was a component of the original Parkland formula, it has been omitted from standard resuscitation for over 30 years. However, some burn centers use as "rescue" therapy patients who exhibit progressively increasing crystalloid requirements, phenomenon termed "fluid creep." We reviewed our experience with this procedure. With Institutional Review Board approval, we all adult > or =20%TBSA burns admitted January 1, 2005, through December 31, 2007, completed formal resuscitation. Patients were resuscitated using adjusted to maintain urine output 50 ml/hr. required greater amounts fluid than expected given combination 5% albumin and lactated Ringer's until requirements normalized. Results expressed an hourly ratio (I/O ratio) infusion (ml/kg/%TBSA/hr) (ml/kg/hr). Predicted values vary individual but are usually less 0.5 1.0. Fifty-two reviewed, whom 26 alone, remaining supplementation (AR). The groups comparable in age, gender, weight, mortality, time between injury admission. AR had larger total full-thickness more inhalation injuries. managed alone maintained mean ratios 0.13 0.40, whereas demonstrated maximum 1.97, started. Administration produced dramatic precipitous return within predicted ranges throughout remainder No patient developed abdominal compartment syndrome. Measuring I/O is effective means expressing tracking requirements. addition rapidly reduces restores normal ratios, ameliorates creep. This practice can be applied selectively needed predetermined algorithms.