[Early treatment for body fluid shifts and circulatory derangement in patients with extensive burns]

Abstract

The initial postburn period is characterized by body fluid shifts and circulatory derangement, or so-called burn shock. The fluid shifts are mainly due to a marked increase in capillary permeability. This loss of capillary integrity is so great that colloid including albumin, readily disperse into the extravascular space. This is limited to the burned area when of 30% or less of the body surface area (BSA) is involved, but is found throughout the entire body when more than 30% of the BSA is involved. The tremendous fluid shifts from the intravascular to the extravascular space result in edema formation and hemoconcentration. Along with the reduction in intravascular volume, there is a rapid reduction in cardiac output which gradually returns to the normal level 24 to 48 hours after burn injury. Therefore fluid resuscitation should be initiated immediately after injury. Currently a number of methods for achieving adequate volume replacement are available. In this paper we review fluid resuscitation methods for patients with extensive burns and also introduce recent topics on new regimens for resuscitation.