Individualized fluid resuscitation based on haemodynamic monitoring in the management of extensive burns.
An evaluation has been made on the effectiveness and feasibility of the individualized fluid replacement programme based on intensive haemodynamic monitoring using a Swan-Ganz catheter. Twenty-one extensively burned patients with an average burn of 60.8 per cent BSA were resuscitated with lactated Ringer's and colloid solutions. The rate of fluid administration was adjusted to maintain the optimal ranges of the various haemodynamic parameters including cardiac index and left ventricular stroke work index. Two patients failed to respond to fluid resuscitation possibly due to inadequate emergency procedures given before arrival at our institute. The remaining patients survived the shock phase, with the amount of fluid given to the 18 adult patients being (3.38 /+- 1.02 ml/kg) x (percentage burn) for the first 24 hours. A negative correlation existed between the amounts of lactated Ringer's solution and colloid solution used for the fluid resuscitation. Dopamine was effective in 4 out of 5 patients who showed depressed myocardial function. The individualized fluid programme was shown to be effective and reliable for the management of critically burned patients.