Der Einfluss der präklinischen Flüssigkeitssubstitution des Verbrennungspatienten auf Therapie und Verlauf im Schwerverbranntenzentrum - Eine Analyse tierexperimenteller und klinischer Daten -

Abstract

Trauma - Analysis of Animal Experimental and Clinical Data. Objective: The optimal prehospital therapy of the severely burned patient with special consideration of immediate fluid administration has to be defined since it is known that inadequate volumes of fluid administration in the early postburn period result in severe complications. Methods: 1. In all Patients (> 18 ys, severely burned, DGV Guidelines) admitted between January 1995 and December 1999 to the Burn Center of the Aachen University the delay between trauma and admission was monitored. 2. In porcine scald-model (30% TBSA) activity of complement system over a 96-hours posttraumatic period were assessed and the effect of immediate C1-inhibitor (C1-Inh) application was evaluated. 3. Complement parameters were prospectively assessed over a 96-hours-period in 27 severely burned patients divided in 3 groups according to Zawacki et al. Results: 286 patients (TBSA 23 %, age + TBSA 66, inhalational injury 29 %) were admitted. The delay in arrival was 0 -1 h: 36%,1-4 h: 37 % and > 4 h: 27%. In the animal model the immediate application of C1-Inh showed significant reduction of CH 50 , 19±8.8% vs. 2.1±11% without C1-lnh and a significant reduction of edema formation. In 27 patients the complex of C1-Inh and C1rC1s-C1-Inh significant for classical pathway activation correlated well with the severity of the trauma (r 2 = 0.25; p = 0.01) and was significantly elevated in the group of the most severely burned patients on admission. The edema formation well correlated (r 2 = 0.48; p = 0.0002) with reduced C1-Inh function. Conclusion: Evaluation of the data and the literature made was leading to guidelines of optimal prehospital therapy of the severely burned patient. The immediate start of intravenous fluid administration after severe burn is most important and complement activation is responsive to rapid resuscitation. The Parkland formula is sufficient for the first 24 hours but in the first hour postburn fluid administration has to be more rapidly. Twice the volume within the first hour is suggested: 0.5 mIRL × %TBSA × kgBW. Stay and play, immediate fluid resuscitation and well planned transport directly to a Burn Unit are indicated.