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Fluid resuscitation in patients with severe burns: a meta-analysis of randomized controlled trials

Department of Emergency, Chi-Mei Medical Hospital, Tainan, Taiwan. Graduate Institute of Medical Sciences, College of Health Science, Chang Jung, Christian University, Tainan, Taiwan. Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. Department of Medical Research, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. Department of Emergency, Chi-Mei Medical Hospital, Tainan, Taiwan. Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan. Department of Emergency, Chi-Mei Medical Hospital, Tainan, Taiwan. Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan. Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan. Department of Emergency, Chi-Mei Medical Hospital, Tainan, Taiwan. Department of Occupational Medicine, Chi-Mei Medical Hospital, Tainan, Taiwan. Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan. Department of Geriatrics and Gerontology, Chi-Mei Medical Hospital, Tainan, Taiwan. Shared Decision Making Resource Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. Department of Emergency, Chi-Mei Medical Hospital, Tainan, Taiwan. Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. Department of Medical Research, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. Shared Decision Making Resource Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taiwan. Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 2017;25((3):):320-329
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Abstract
OBJECTIVES Fluid resuscitation is the mainstay treatment to reconstitute intravascular volume and maintain end-organ perfusion in patients with severe burns. The use of a hyper-osmotic or iso-osmotic solution in fluid resuscitation to manage myocardial depression and increased capillary permeability during burn shock has been debated. We conducted a systematic review and meta-analysis to compare the efficacies of hyper-osmotic and iso-osmotic solutions in restoring hemodynamic stability after burn injuries. METHODS PubMed, Embase, Cochrane Library, Scopus, and ClinicalTrials. gov registry were searched. Randomized control trials evaluating the efficacy and safety of hyper-osmotic and iso-osmotic fluid resuscitation in patients with burn injuries were selected. Eligible trials were abstracted and assessed for the risk of bias by 2 reviewers and results of hemodynamic indicators in the included trials were analyzed. RESULTS Ten trials including 502 participants were published between 1983 and 2013. Compared with iso-osmotic group, the hyper-osmotic group exhibited a significant decrease in the fluid load (vol/%TBSA/weight) at 24 h postinjury, with a mean difference of -0.54 (95% confidence interval = -0.92 to -0.17). No differences were observed in the urine output, creatinine level, and mortality at 24 h postinjury between groups. CONCLUSIONS Hyper-osmotic fluid resuscitation appears to be an attractive choice for severe burns in terms of total body surface area or burn depth. Further investigation is recommended before conclusive recommendation. This article is protected by copyright. All rights reserved.
Study details
Study Design : Systematic Review
Language : English
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine