Fluid resuscitation in burn patients with sepsis
Keywords:burns, sepsis, intoxication, hemodynamic disorders, Reosorbylact
Background. There are several differences between sepsis surgical patients and burn sepsis. The effects of mediators and pathogens lasts for months if burn injury is greater than 30 % TBSA. The purpose is to improve the fluid therapy regimens for burn septicotoxemia and burn sepsis.
Materials and methods. The study is based on the observation of 52 patients with burn sepsis treated at the Kyiv City Clinical Hospital No. 2 during 2017–2019. The patients were divided into three groups: first group received Ringer lactate, sodium chloride and other iso-osmolar solutions, second group – Ringer lactate + Reosorbylact at a dose of 10 ml/kg per day, third group – Ringer lactate + Reosorbylact at a dose of 15 ml/kg per day.
Result. Patients received plasma to correct the wrapping system, 20 % albumin was administered when total protein level was below 50g/l. Daily use of Reosorbylact at a dose of 10–15 ml/mg helped to reduce the number of leukocytes, leukocyte intoxication index, low molecular weight metabolites (urea and creatinine), as well as the content of MSM in plasma (1.6 times), and reduce the activity of AST and ALT, lowering the level of CRР. During the observation in patients of groups 2 and 3 there was a significantly lower heart rate than in the group of crystalloids (P = 0.002), as well as higher mean blood pressure (P = 0.03), an increase in diuresis. The 24-hour fluid balance in the patients of the study groups was respectively: 64 ml/kg; 60 ml/kg and 52 ml/kg. Septic shock developed in 15.7 %, 11.8 % and 12.5 % patients of the study groups. Patients had a shorter duration of treatment with vasopressors (2.8 ± 1.5 days vs. 4.7 ± 1.4 days).
- The use of reosorbylact for patients with burn sepsis has led to a decrease in the overall fluid balance during the day.
- The incidence of septic shock decreased by 3.9 % and 3.2 % in the groups where Reosorbylact was used, the duration of vasopressor treatment decreased by 0.4 and 1.9 days.
- The detoxication and hemodynamic effect of Reosorbylact has been proved.
- A dose-dependent effect of Reosorbylact was observed.
The study had some limitations. Thus, the conclusion of the study needs further study with more sampling
Greenhalgh DG. Sepsis in the burn patient: a different problem than sepsis in the general population. Burns & Trauma [Internet]. Oxford University Press (OUP); 2017 Aug 8;5. Available from: https://doi.org/10.1186/s41038-017-0089-5
Morrison VV, Bozhedomov AY, Simonyan MA, Morrison AB. Systemic inflammatory response and cytokine profile in the dynamics of burn disease [Morrison VV, Bozhedomov AYU, Simonyan MA, Morrison AV. Sistemnyy vospalitel'nyy otvet i tsitokinovyy profil' v dinamike razvitiya ozhogovoy bolezni]. Saratov Journal of Medical Scientific Research. 2017; 13 (2). 229–232. https://cyberleninka.ru/article/n/sistemnyy-vospalitelnyy-otvet-i-tsitokinovyy-profil-v-dinamike-razvitiya-ozhogovoy-bolezni/viewer [In Russian].
Ilyinsky ME, Lyashchenko UN, Ryk AA, Bocharov DE. Current opportunities to reduce the intensity of hypermetabolism in severe thermal injury (literature review) [Il'inskiy ME, Lyashchenko YUN, Ryk AA, Bocharov DE. Sovremennyye vozmozhnosti snizheniya intensivnosti gipermetabolizma pri tyazheloy termicheskoy travme (obzor literatury).]. Magazine them. Sklifosovsky NV Emergency medical care. 2016 (3):55–64. [In Russian].
Martins EC, Silveira L da F, Viegas K, Beck AD, Fioravantti Júnior G, Cremonese RV, et al. Neutrophil-lymphocyte ratio in the early diagnosis of sepsis in an intensive care unit: a case-control study. Revista Brasileira de Terapia Intensiva [Internet]. GN1 Genesis Network; 2019;31(1). Available from: https://doi.org/10.5935/0103-507x.20190010
Kursov SV, Nikonov VV. Surviving Sepsis Campaign Guidelines: evolution of early goal-directed therapy. EMERGENCY MEDICINE. 2018(4.91):7-14. https://doi.org/10.22141/2224-05184.108.40.2068. 137849.
Sorokina EYU, Dubrov SA. 2016 is a new step in the diagnosis and treatment of sepsis and septic shock. Pain, analgesia and intensive care. 2016 (4): 7-15.
Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of Clinical Criteria for Sepsis. JAMA [Internet]. American Medical Association (AMA); 2016 Feb 23;315(8):762. Available from: https://doi.org/10.1001/jama.2016.0288
Semler MW, Rice TW. Sepsis Resuscitation. Clinics in Chest Medicine [Internet]. Elsevier BV; 2016 Jun;37(2):241–50. Available from: https://doi.org/10.1016/j.ccm.2016.01.007
Konovchuk VM, Andrushchak AV. Clinical and experimental pathology. Volume XV, 2016;3(57):64-68.
Kononchuk VM, Andrushchak AV. The influence of reosorbilact on the circulatory system in patients with severe sepsis. Clin. and experim. pathol.- 2016;Vol.15,3(57):64-68. [In Ukrainian].
Cherniy VI, Shlapak IP, Georgiyants MA, Tyumentseva SG, Kugler SY, Prokopenko BB. Etiology, Pathogenesis and Intensive Care of Metabolic Acidosis. Emergency medicine [Internet]. Publishing House Zaslavsky; 2016 Nov 21;0(6.77):153–66. Available from: https://doi.org/10.22141/2224-05220.127.116.116.82183
Mishnev OD, Tumanova UN, Schegolev AI. Pathology of the liver in sepsis. International journal of applied and fundamental research, 2017;8:267–271 [In Russian].
How to Cite
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License