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Vasoactive and/or inotropic drugs in initial resuscitation of burn injuries: A systematic review

Department of Plastic, Hand and Reconstructive Surgery, Norwegian National Burn Center, Haukeland University Hospital, P. O. Box 1400, Bergen, Norway. Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, P. O. Box 4950 Nydalen, Oslo, Norway. Department of Anaesthesia and Intensive Care, Haukeland University Hospital, P. O. Box 1400, Bergen, Norway. Department of Clinical Medicine, Faculty of Medicine, University of Bergen, P. O. Box 7804, Bergen, Norway. Specialised Health Care services, Quality and Clinical Pathways, Norwegian Directorate of Health, P. O. Box 220, Skøyen, Oslo, Norway.

Acta anaesthesiologica Scandinavica. 2022
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Abstract
BACKGROUND According to current guidelines initial burn resuscitation should be performed with fluids alone. The aims of the study were to review the frequency of use of vasoactive and/or inotropic drugs in initial burn resuscitation, and assess benefits and harms of adding such drugs to fluids. METHODS A systematic literature search was conducted in PubMed, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, UpToDate, and SveMed+ through 3 December 2021. The search included studies on critically ill burn patients receiving vasoactive and/or inotropic drugs in addition to fluids within 48 hours after burn injury. RESULTS The literature search identified 1058 unique publications that were screened for inclusion. After assessing 115 publications in full text, only two retrospective cohort studies were included. One study found that 16 out of 52 (31%) patients received vasopressor(s). Factors associated with vasopressor use were increasing age, burn depth and % total body surface area (TBSA) burnt. Another study observed that 20 out of 111 (18%) patients received vasopressor(s). Vasopressor use was associated with increasing age, Baux score and %TBSA burnt in addition to more frequent dialysis treatment and increased mortality. Study quality assessed by the Newcastle-Ottawa quality assessment scale was considered good in one study, but uncertain due to limited description of methods in the other. CONCLUSION This systematic review revealed that there is lack of evidence regarding benefits and harms of using vasoactive and/or inotropic drugs in addition to fluids during early resuscitation of patients with major burns.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine