1.
Clinical study of plasma substitute (Gelofusion) on fluid resuscitation in patients with burned shock Chinese
Zhao XD, Dang W, He ZJ, Zhang X, Yan BG, Yao YM
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue [Chinese Critical Care Medicine]. 2003;15((5):):265-7.
Abstract
OBJECTIVE To investigate the effects of plasma substitute (Gelofusion) on fluid resuscitation in patients with burned shock. METHODS Twenty burn shock patients with total body surface area (TBSA) more than 40% were enrolled for clinical study on the effect of resuscitation with plasma substitute (Gelofusion). The patients were randomly divided into two groups: Gelofusion resuscitation group (n=11) and plasma resuscitation group (n=9). The cardiac output (CO),oxygen delivery (DO2), packed cell volume (PCV), blood and plasma viscosity, lactate(LA) and base deficit (BD) levels were detected at shock stage (postburn from 1 to 48 hours). RESULTS Two hours after rapid fluid replacement, the levels of CO and DO2 were gradually increased, while the levels of PCV, blood and plasma viscosity, LA and BD were markedly decreased (P<0. 05 or P<0. 01). After resuscitation, plasma viscosity in Gelofusion resuscitation group were obviously lower than that in plasma resuscitation group within 24 hours postburn (all P<0. 05). With an exception of plasma viscosity, there were no significant differences in other parameters between two groups at various intervals (all P>0. 05). CONCLUSION In the resuscitation of burn shock, the clinical effect of Gelofusion treatment is similar to that of plasma treatment. Gelofusion appears to be a fairly good plasma substitute for extensive application on the management of burn shock during the early stage.
2.
Prophylactic anti-lipopolysaccharide freeze-dried plasma in major burns: a double blind controlled trial
Jones EB
Burns. 1995;21((4):):267-72.
Abstract
A double-blind controlled trial to test the efficacy of freeze-dried plasma containing a high titre of anti-lipopolysaccharide (anti-LPS) IgG in preventing or reducing sepsis in burns was carried out on 60 consecutive consenting adult burn victims with burns between 20 and 55 per cent of body surface area. Statistics failed to demonstrate a reduction in the mortality (P = 0.12) but did demonstrate a reduction in the incidence of burn wound infection (P = 0.0443), a fall in endotoxin levels in the first week (P = 0.041) and a rise in the anti-endotoxin levels after 5 units of anti-LPS plasma (P = 0.027). The logistics of carrying out such a trial are difficult but a larger patient population and modification of the original protocol might demonstrate a significant fall in mortality and morbidity. It was felt that some of the positive benefits of the high titre anti-LPS plasma might be due to factors other than the anti-LPS IgG.
3.
Ionized hypocalcemia after fresh frozen plasma administration to thermally injured children: effects of infusion rate, duration, and treatment with calcium chloride
Cote CJ, Drop LJ, Hoaglin DC, Daniels AL, Young ET
Anesthesia & Analgesia. 1988;67((2):):152-60.
Abstract
A number of cardiac arrests and severe hypotensive episodes have been witnessed associated with the intravenous infusion of fresh frozen plasma (FFP). To clarify the possible role of hypocalcemia, 28 thermally injured anesthetized pediatric patients with massive blood loss were studied to examine the cardiovascular responses (mean arterial pressure [MAP], heart rate, ECG) to 49 infusions of FFP. Rapid, statistically significant reductions in ionized calcium ([Ca2+]) followed each of four rates (1.0, 1.5, 2.0, and 2.5 ml.kg-1.min-1 for 5 minutes) of FFP infusion (P less than 0.0001). The slowest rate resulted in significantly less reduction in [Ca2+] than did the higher infusion rates (P less than 0.002). In five children MAP decreased greater than or equal to 20% below baseline levels, but this was not correlated with rate of FFP administration or decrease in [Ca2+]. The decreases in [Ca2+] and MAP were inversely related to age and unrelated to anesthetic technique. Changes in the Q-oTc interval were not related to [Ca2+]. Adverse cardiovascular responses and reduced [Ca2+] were not significantly different between 5- and 10-minute FFP infusions. Fewer fluctuations in MAP occurred when calcium chloride (CaCl2) was administered; the least fluctuation in [Ca2+] occurred when CaCl2 was administered during the plasma infusion. It is concluded that in thermally injured children 1-17 years old: 1) Rapid infusions of FFP produce sudden but evanescent decreases in [Ca2+]; more rapid infusions result in greater reductions in [Ca2+]. 2) There is no correlation between [Ca2+] and systemic hypotension. 3) Clinically important decreases in MAP occasionally accompany the rapid infusion of FFP.(ABSTRACT TRUNCATED AT 250 WORDS)
4.
The concentration of plasma fibronectin in burns patients treated with fresh frozen plasma or plasma protein fraction
Boughton BJ, Simpson A, Baar S, Ala F, Casson J, Gower J
Resuscitation. 1984;12((1):):41-5.
Abstract
A group of 10 patients with 30-70% burns were given intravenous infusions during the first 48 h following hospital admission either with fresh frozen plasma (FFP) or human plasma protein fraction ( HPPF ). FFP contained 300-400 mg/dl plasma fibronectin whereas none was detectable in HPPF . Circulating plasma fibronectin levels fell quickly in those patients receiving HPPF and levels remained low for 2-3 weeks. In those receiving FFP, plasma fibronectin remained normal during the 48-h transfusion period but fell subsequently. Fibronectin may be an important determinant in the resistance to shock and infections. Consideration should therefore be given to the use of blood products which contain fibronectin and to the monitoring of plasma levels both during the acute and recovery periods after burn injury.
5.
Fresh-frozen plasma vs. plasma protein derivative as adjunctive therapy for patients with massive burns
Alexander JW, Ogle CK, Stinnett JD, White M, MacMillan BG, Edwards BK
Journal of Trauma-Injury Infection & Critical Care. 1979;19((7):):502-11.
Abstract
Twenty patients with burn injuries involving 45% or more total body surface area were randomly allocated to receive either fresh-frozen plasma (plasma), 200 ml/m2/d (11 patients), or an approximately equal amount of plasma protein derivative (Plasmanate) (nine patients) during the first 45 days postburn. To study the potential effects of these two adjunctive therapies on host resistance to infection, measurements were made twice weekly of the antibacterial funciton of neutrophils, the opsonic index (ability to opsonize alternative pathway dependent E. coli 075), C3(B), IgG, properdin, factor B, total protein, and albumin. The average size of burn in the plasma group was 61.5% total and 42% 3 degrees compared with 61% total and 46% 3 degrees in the Plasmanate group. Ten and 18 episodes of bacteremia occurred in the plasma and Plasmanate groups, respectively. Analysis of the results indicates only slightly better support of host resistance when plasma is administered, but this is counterbalanced by the increased risk of viral hepatitis.
