RT Journal
A1 Murphy JT, Horton JW, Purdue GF, Hunt JL
T1 CArdiovascular effect of 7.5% sodium chloride–dextran infusion after thermal injury
JF Archives of Surgery
JO Archives of Surgery
YR 1999
FD October 1
VO 134
IS 10
SP 1091
OP 1097
DO 10.1001/archsurg.134.10.1091
UL http://dx.doi.org/10.1001/archsurg.134.10.1091
AB Hypothesis 
    Clinical study can help determine the safety and cardiovascular and systemic effects of an early infusion of 7.5% sodium chloride in 6% dextran-70 (hypertonic saline–dextran-70 [HSD]) given as an adjuvant to a standard resuscitation with lactated Ringer (RL) solution following severe thermal injury.Design 
    Prospective clinical study.Setting 
    Intensive care unit of tertiary referral burn care center.Patients 
    Eighteen patients with thermal injury over more than 35% of the total body surface area (TBSA) (range, 36%-71%) were studied.Interventions 
    Eight patients (mean ± SEM, 48.2%±2% TBSA) received a 4-mL/kg HSD infusion approximately 3.5 hours (range, 1.5-5.0 hours) after thermal injury in addition to routine RL resuscitation. Ten patients (46.0%±6% TBSA) received RL resuscitation alone.Main Outcome Measures 
    Pulmonary artery catheters were employed to monitor cardiac function, while hemodynamic, metabolic, and biochemical measurements were taken for 24 hours.Results 
    Serum troponin I levels, while detectable in all patients, were significantly lower after HSD compared with RL alone (mean ± SEM, 0.45±0.32 vs 1.35±0.35 µg/L at 8 hours, 0.88±0.55 vs 2.21±0.35 µg/L at 12 hours). While cardiac output increased proportionately between 4 and 24 hours in both groups (from 5.79±0.8 to 9.45±1.1 L/min [mean ± SEM] for HSD vs from 5.4±0.4 to 9.46±1.22 L/min for RL), filling pressure (central venous pressure and pulmonary capillary wedge pressure) remained low for 12 hours after HSD infusion (P=.048). Total fluid requirements at 8 hours (2.76±0.7 mL/kg per each 1% TBSA burned [mean ± SEM] for HSD vs 2.67±0.24 mL/kg per each 1% TBSA burned for RL) and 24 hours (6.11±4.4 vs 6.76±0.75 mL/kg per each 1% TBSA burned) were similar. Blood pressure remained unchanged, and serum sodium levels did not exceed 150±2 mmol/L (mean ± SD) in either group.Conclusions 
    The absence of deleterious hemodynamic or metabolic side effects following HSD infusion in patients with major thermal injury confirms the safety of this resuscitation strategy. Postburn cardiac dysfunction was demonstrated in all burn patients through the use of cardiospecific serum markers and pulmonary artery catheter monitoring. Early administration of HSD after a severe thermal injury may reduce burn-related cardiac dysfunction, but it had no effect on the volume of resuscitation or serum biochemistry values.