Introduction: Evaluation and management of hemodynamic status are a central challenge in caring for the critically ill burn patients. Whereas under resuscitation results in inadequate organ perfusion, accumulating data suggest that over resuscitation also appears to impede oxygen delivery and compromise outcome in patients with serious burn (Fig.1). Indices reflecting the hemodynamic changes during mechanical ventilation, the dynamic indices of fluid responsiveness have been intensively investigated in the past years in critically ill patients. The aim of this study was to evaluate cardiac output and other hemodynamic parameters obtained by FloTrac/Vigileo™ system during the fluid resuscitation of postburn shock. Methods: A prospective study enrolling 23 patient with severe burn injury was performed. Patients with pacemakers, history of cardiac arrhythmia, severe peripheral vascular disease, cardiac support (intra-aortic balloon pump), and persisting mitral or aortic dysfunction after surgery were excluded. Hemodynamic parameters and lactate levels were recorded every 8 h during the first day postburn and at the 36th hour after burn trauma. The patients remained sedated during the study period using propofol (1–2 mg/kg/h) and remifentanil (2–5 mg/kg/h). All patients were mechanically ventilated in a volume-controlled mode. Resuscitation therapy was guided by the data of the hemodynamic monitoring. Statistical analysis. Hemodynamic variables for each time interval were compared with the baseline by analysis of variance (ANOVA) for repeated measurements. P < 0.05 was considered to represent a statistically significant difference. Results: All patients were resuscitated successfully. There was a significant increase in cardiac index (CI) and a decrease in stroke volume variation (SVV) and systemic vascular resistance index (SVRI), (p < 0.01) during the first 36 hours after the injury. Central venous pressure (CVP) showed significant changes over this time period; significant decrease in lactate levels was also observed. However we did not observe any significant change in oxygen delivery index (DO2I, 680±247ml/min/m2 vs. 665±262ml/min/m2) which was within physiological range during the early postburn period. Patients’ clinical data on admission are shown in Table 1. Table 2 displays the average hemodynamic data at the defined time intervals. Tab.1. Patients’ data Age, years male/female TBSA,% SOFA Inhalation injury,% 28 day mortality, % Fluids, day 1, ml/kg/%TBSA, UO, ml/kg/h 51.8±16 18/5 49±20.5 2.2±1 26 8.7 3.7±1.5 1.4±0.5 TBSA, total burn surface area; SOFA, Sequential Organ Failure Assessment score. Table 2. Patients’ hemodynamic parameters. Hours 1 8 16 24 36 CI l/min m-2 2.2±1.1 1.8±1 2.8±0.7 2.9±1.2 3.7±0.9 SVV (%) 22.5±4 24.6±4.6 18.6±7 15.3±8 12.6±4.3 SVRI (dynes s cm-5 m-2) 2579±690 2890±887 2209±887 1878±345 1575±525 CVP (mmHg) 7.7±3 7.9±4,1 8±2.1 8.1±3.4 11±4 Lactate (mmol l-1) 3.7±2.7 4.4±3.4 3.2±2 2.1±1.5 1.8±0.7 Base excess BE (mEq l-1) -6.3± -5 -7.3± -3 -6.3± -5 -3.3± -2 -1.8±-2 Tidal volume (ml kg-1) 7.2±1.1 7±2.3 7±2.5 7.3±1.8 6.9±2 PEEP (cm H2O) 5.6±2.2 5.5±2 5.7±2.2 6±1.8 6.2±2.5 Conclusion: Significant positive hemodynamic effects on static and dynamic parameters of initial fluid resuscitation were observed in burn patients. Oxygen delivery index was within physiological range during the investigation period.
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