open access

Vol 47 (2015): Special issue
Review articles
Published online: 2015-10-20
Submitted: 2015-09-05
Accepted: 2015-10-03
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An overview on fluid resuscitation and resuscitation endpoints in burns: Past, present and future. Part 2 — avoiding complications by using the right endpoints with a new personalized protocolized approach

Yannick Peeters, Marnix Lebeer, Robert Wise, Manu L.N.G. Malbrain
DOI: 10.5603/AIT.a2015.0064

open access

Vol 47 (2015): Special issue
Review articles
Published online: 2015-10-20
Submitted: 2015-09-05
Accepted: 2015-10-03

Abstract

While organ hypoperfusion caused by inadequate resuscitation has become rare in clinical practice due to the better
understanding of burn shock pathophysiology, there is growing concern that increased morbidity and mortality
related to over-resuscitation induced by late 20th century resuscitation strategies based on urine output, is occurring
more frequently in burn care. In order to reduce complications related to this concept of “fluid creep”, such as
respiratory failure and compartment syndromes, efforts should be made to resuscitate with the least amount of fluid
to provide adequate organ perfusion. In this second part of a concise review, the different targets and endpoints
used to guide fluid resuscitation are discussed. Special reference is made to the role of intra-abdominal hypertension
in burn care and adjunctive treatments modulating the inflammatory response. Finally, as urine output has been
recognized as a poor resuscitation target, a new personalized stepwise resuscitation protocol is suggested which
includes targets and endpoints that can be obtained with modern, less invasive hemodynamic monitoring devices
like transpulmonary thermodilution.

Abstract

While organ hypoperfusion caused by inadequate resuscitation has become rare in clinical practice due to the better
understanding of burn shock pathophysiology, there is growing concern that increased morbidity and mortality
related to over-resuscitation induced by late 20th century resuscitation strategies based on urine output, is occurring
more frequently in burn care. In order to reduce complications related to this concept of “fluid creep”, such as
respiratory failure and compartment syndromes, efforts should be made to resuscitate with the least amount of fluid
to provide adequate organ perfusion. In this second part of a concise review, the different targets and endpoints
used to guide fluid resuscitation are discussed. Special reference is made to the role of intra-abdominal hypertension
in burn care and adjunctive treatments modulating the inflammatory response. Finally, as urine output has been
recognized as a poor resuscitation target, a new personalized stepwise resuscitation protocol is suggested which
includes targets and endpoints that can be obtained with modern, less invasive hemodynamic monitoring devices
like transpulmonary thermodilution.

Get Citation

Keywords

burns; fluid resuscitation; monitoring; treatment; resuscitation endpoint/target; de-resuscitation; abdominal pressure; abdominal hypertension; abdominal compartment syndrome; personalized care; protocol; algorithm

About this article
Title

An overview on fluid resuscitation and resuscitation endpoints in burns: Past, present and future. Part 2 — avoiding complications by using the right endpoints with a new personalized protocolized approach

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 47 (2015): Special issue

Pages

15-26

Published online

2015-10-20

DOI

10.5603/AIT.a2015.0064

Keywords

burns
fluid resuscitation
monitoring
treatment
resuscitation endpoint/target
de-resuscitation
abdominal pressure
abdominal hypertension
abdominal compartment syndrome
personalized care
protocol
algorithm

Authors

Yannick Peeters
Marnix Lebeer
Robert Wise
Manu L.N.G. Malbrain

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