Abstract
IntroductionThere are limited data on the efficacy of early fluid resuscitation with third-generation hydroxyethyl starch (HES 130) in burn injury. Adverse effects of HES on survival and organ function have been reported.MethodsIn this randomized, controlled, double-blind trial, 48 patients with severe burn injury were assigned to receive either lactated Ringer’s solution plus 6% HES 130/0.4 in a ratio of 2:1 or lactated Ringer’s solution with no colloid supplement for the first 72 hours. Primary outcome parameter was the group difference of administered total fluid from intensive care unit (ICU) admission up to day 3. Secondary outcomes included kidney and lung injury and failure, length of stay, and mortality.ResultsThree-day totals of administered resuscitation fluid (medians) were 21,190 mL in the lactated Ringer’s group and 19,535 mL in the HES group (HES: −1,213 mL; P = 0.39). Creatinine levels from day 1 to 3 (HES: +0.4 μmol/L; 95% confidence interval (CI) −18.7 to 19.5; P = 0.97) and urinary outputs from day 1 to 3 (HES: −58 mL; 95% CI −400 to 283; P = 0.90) were not different. Six patients in each group developed acute respiratory distress syndrome (ARDS) (risk ratio 0.96; 95% CI 0.35 to 2.64; P = 0.95). Length of ICU stay (HES vs. lactated Ringer’s: 28 vs. 24 days; P = 0.80) and length of hospital stay (31 vs. 29 days; P = 0.57) were similar. Twenty-eight-day mortality was 4 patients in each group (risk ratio 0.96; 95% CI 0.27 to 4.45; P = 0.95), and in-hospital mortality was 8 in the HES group vs. 5 patients in the lactated Ringer’s group (hazard ratio 1.86; 95% CI 0.56 to 6.19; P = 0.31).ConclusionsThere was no evidence that early fluid resuscitation with balanced HES 130/0.4 (6%) in addition to lactated Ringer’s solution would lead to a volume-sparing effect in severe burn injury. Together with the findings that early renal function, incidence of ARDS, length of stay, and mortality were not negatively influenced by HES in this setting, balanced HES 130/0.4 (6%) plus lactated Ringer’s solution could not be considered superior to lactated Ringer’s solution alone.Trial registrationClinicalTrials.gov NCT01012648
Highlights
There are limited data on the efficacy of early fluid resuscitation with third-generation hydroxyethyl starch (HES 130) in burn injury
The capillary leak is believed to resolve within 8 to 24 hours after trauma, but data vary [1,5]. In this critical situation of massive inflammation, hypovolemia, and large edema formation, it remains unclear whether a “crystalloid only” therapy or a combination of crystalloids plus colloids should be used for volume resuscitation
In 1998 the Cochrane Injuries Group presented a relative risk of death after albumin administration of 2.4 in a meta-analysis [9], human albumin is still used in burn to reduce the fluid requirements for resuscitation [10,11] and tissue edema
Summary
There are limited data on the efficacy of early fluid resuscitation with third-generation hydroxyethyl starch (HES 130) in burn injury. The least side effects on kidney function and coagulation are attributed to the third-generation HESs such as HES 130/0.4 (6%), but data on early fluid resuscitation in major burn with these modern starches are limited. In this current randomized controlled trial we addressed the question of whether modern HES 130/0.4 (6%) administered within the first 24 hours after severe burn injury and up to 72 hours of treatment would be able to show any fluid-sparing effect
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