Gastrointestinal Fluid Resuscitation of Thermally Injured Patients.

摘要

A seminal advance in the care of thermally injured patients was the recognition of the large volumes of fluid required during resuscitation and the relationship of these volumes to burn size and body weight. This discovery resulted in the virtual elimination of acute renal failure as a consequence of burn shock. Today, the established standard of care focuses on the intravenous route for fluid resuscitation, and time to intravenous access was an independent predictor of mortality in a study of children with massive burns by Wolf et al. Historically, however, several other methods have been used for delivery of fluids to patients with burn shock, including oral, rectal, and subdermal routes. Several factors led to the preferential use of the intravenous route. It enables the immediate delivery of known quantities of fluid and allows the rapid correction of circulating volume deficits. By contrast, the other routes provide uncertain amounts of fluid at more gradual rates, and vomiting may complicate oral fluid intake. Finally, plasma or albumin solutions can only be given intravenously.