Mackie David P, Spoelder Ed J, Paauw Roel J, Knape Paul, Boer Christa
Department of Anesthesiology, Burns Center, Red Cross Hospital, Beverwijk, the Netherlands.
J Trauma. 2009 Dec;67(6):1233-8; discussion 1238. doi: 10.1097/TA.0b013e3181be9c67.
Burn patients with inhalation injury (INHI) require more fluid resuscitation than patients without INHI. However, the relation between INHI and fluid resuscitation may be confounded by a ventilation-induced increase in fluid retention. We therefore evaluated whether INHI was independently of continuous positive pressure ventilation (CPPV) associated with increased fluid retention.
One hundred eighty-six patients with burns of >20% of total body surface area admitted to the Beverwijk Burns Center (1995-2006) were retrospectively studied. Cumulative fluid balance, defined as the total volume of fluids administered from the time of admission minus the total volume of fluids collected from each patient, was calculated at the end of days 3 (FB3) and 7 (FB7) postburn. The population was divided into three groups: (1) INHI-CPPV- (no INHI, no ventilation; n = 75); (2) INHI-CPPV+ (no INHI with ventilation; n = 62); and (3) INHI+CPPV+ (INHI with ventilation; n = 49). Analyses were corrected for differences in age, weight, and % total body surface area.
Patients who were mechanically ventilated were older and had more extensive burns than those who were not ventilated. Baseline characteristics of patients without INHI who were treated by CPPV were similar to patients with INHI, also treated by CPPV. FB3 was significantly higher in patients without INHI who were ventilated compared with nonventilated patients (13.4 +/- 5.8 L vs. 23.1 +/- 10.6 L for INHI-CPPV- and INHI-CPPV+ respectively, p = 0.001). However, fluid balance was not additionally affected by the presence of INHI. The difference in fluid retention between nonventilated and ventilated patients was also seen on day 7 (22.1 +/- 9.4 L vs. 34.2 +/- 15.9 L for INHI-CPPV- and INHI-CPPV+, respectively, p = 0.001).
These results suggest that increased fluid retention, which is conventionally associated with INHI, is due to the effects of ventilation and not to the effects of INHI itself. This warrants a closer evaluation of patients who are ventilated in the absence of INHI, with a view to early extubation.
与无吸入性损伤（INHI）的烧伤患者相比，有INHI的烧伤患者需要更多的液体复苏。然而，INHI与液体复苏之间的关系可能会因通气引起的液体潴留增加而混淆。因此，我们评估了INHI是否独立于与液体潴留增加相关的持续正压通气（CPPV）。
回顾性研究了1995年至2006年入住贝弗维克烧伤中心、烧伤面积超过全身表面积20%的186例患者。计算烧伤后第3天（FB3）和第7天（FB7）结束时的累积液体平衡，定义为从入院时给予的液体总量减去从每个患者收集的液体总量。将患者分为三组：（1）INHI-CPPV-（无INHI，无通气；n = 75）；（2）INHI-CPPV+（无INHI但通气；n = 62）；（3）INHI+CPPV+（有INHI且通气；n = 49）。对年龄、体重和全身表面积百分比的差异进行了分析校正。
接受机械通气的患者比未通气的患者年龄更大，烧伤面积更广。接受CPPV治疗的无INHI患者的基线特征与也接受CPPV治疗的有INHI患者相似。通气的无INHI患者的FB3显著高于未通气患者（INHI-CPPV-组为13.4±5.8 L，INHI-CPPV+组为23.1±10.6 L，p = 0.001）。然而，液体平衡并未因INHI的存在而受到额外影响。在第7天也观察到未通气和通气患者之间液体潴留的差异（INHI-CPPV-组为22.1±9.4 L，INHI-CPPV+组为34.2±15.9 L，p = 0.001）。
这些结果表明，传统上与INHI相关的液体潴留增加是由于通气的影响，而不是INHI本身的影响。这就需要对无INHI时接受通气的患者进行更密切的评估，以期早期拔管。
