Effects of inhalation injuries on the initial fluid requirements for lung oxygenation in flame burn patients

摘要

To clarify the effects of inhalation injuries on initial fluid requirements and lung oxygenation, we compared the fluid volume administered during the first 24 hours postburn and the PaO2/FIO2 on admission and 24 hours after postburn between 22 burn patients with (inhalation group) and without (non-inhalation group) inhalation injuries. Patients received fluid therapy according to a modified Parkland formula, aimed at maintaining an hourly urine output of around 2ml/kg. Colloid was initiated on and after the 6 hour postburn period in a patient whose serum protein dropped below 3 g/dl during resuscitation. Inhalation injuries were diagnosed by fiberoptic bronchoscope findings Age, %TBSA, Burn Index and the time (h) elapsed from onset to hospital arrival were comparable between the two groups. The inhalation group revealed a high mortality rate compared to the non-inhalation group (p = 0.0546). Actual fluid requirements divided by body weight (ml/kg) in the inhalation group were higher than in the non -inhalation group (p<0.05). A linear regression analysis using each data set of actual fluid requirements (ml/kg) and %TBSA in each group showed that the actual fluid requirement (ml/kg) could be expressed as an equation of 86.5+6.0 x %TBSA in the inhalation group and 49.9 + 6.1 x %TBSA in the non-inhalation group. Therefore, inhalation injuries without cutaneous burns may need additional fluids supplied at a rate of 37 ml/kg. The degree of worsening of lung oxygenation after the 24 hour postburn period was not different between the two groups In conclusion, inhalation injuries associated with cutaneous burns may induce an additional fluid requirement during the initial fluid resuscitation stage.