烧伤复苏：ISBI/ABA 调查结果。

Burn resuscitation: the results of the ISBI/ABA survey.

机构信息

Shriners Hospitals for Children Northern California, 2425 Stockton Blvd., Sacramento, CA 95817, USA.

出版信息

Burns. 2010 Mar;36(2):176-82. doi: 10.1016/j.burns.2009.09.004. Epub 2009 Dec 16.

DOI:10.1016/j.burns.2009.09.004

PMID:20018451

Abstract

INTRODUCTION

There are valid concerns that burn shock resuscitation is inadequate; a tendency to over-resuscitate the patient seems to exist which may increase complications such as compartment syndrome. The purpose of this study was to survey members of the ISBI and ABA to determine current practices of burn resuscitation.

METHODS

A survey asking for practices of burn shock resuscitation was provided to all participants of a recent ABA meeting. Around the same time, the survey was sent to all members of the ISBI through the internet. The results of the 101 respondents (ABA--59, ISBI--42, approximately a 15% response rate) are described.

RESULTS

Surveys were returned from all the continents except Africa. Respondents included directors (48%), staff physicians (19%), nurses (23%) and others. Most programs admitted adults (87%) and children (75%) with a mean of 289 admissions per year. The cut off to initiate resuscitation was 15% TBSA and most preferred peripheral IVs (70%) and central lines (47.5%). The Parkland formula was preferred (69.3%) while others were used: Brooke--6.9%, Galveston--8.9%, Warden--5.9%, and colloid 11.9%. Lactated Ringer's (LR) was the preferred solution (91.9%), followed by normal saline--5%, hypertonic saline--4%, albumin--20.8%, FFP--13.9%, and LR/NaHCO(3)--12.9%. Approximately half (49.5%) added colloid before 24h. Urine output is the major indicator of success (94.9%) while 22.7% use other monitors. Most (88.8%) feel their protocols work well, with 69.8% feel that it provides the right amount of fluid (24%--too much, 7%--too little). Despite this feeling, they still feel that they give more fluid than the formula in 55.1%, less than formula in 12.4% and the right amount in 32.6%. Approximately 1/3 use an oral resuscitation formula and 81.8% feel that an oral formula works for burns<15% TBSA.

CONCLUSION

Large variations exist in resuscitation protocols but the Parkland formula using LR is still the dominant method. Most feel that their resuscitation protocol works well.

摘要

简介

人们对烧伤休克复苏是否充分存在合理的担忧；似乎存在过度复苏患者的倾向，这可能会增加并发症，如间隔综合征。本研究的目的是调查 ISBI 和 ABA 的成员，以确定烧伤复苏的当前实践。

方法

向最近一次 ABA 会议的所有参与者提供了一份关于烧伤休克复苏实践的调查问卷。与此同时，通过互联网向所有 ISBI 成员发送了该调查。描述了 101 名受访者（ABA-59，ISBI-42，约 15%的回复率）的结果。

结果

除非洲外，所有大陆都有回复。受访者包括主任（48%）、主治医生（19%）、护士（23%）和其他人员。大多数项目收治成人（87%）和儿童（75%），每年平均收治 289 人。开始复苏的截止值为 15%TBSA，大多数人更喜欢外周静脉（70%）和中心静脉（47.5%）。首选帕克兰公式（69.3%），而其他公式包括布鲁克（6.9%）、加尔维斯顿（8.9%）、沃登（5.9%）和胶体（11.9%）。乳酸林格氏液（LR）是首选溶液（91.9%），其次是生理盐水（5%）、高渗盐水（4%）、白蛋白（20.8%）、FFP（13.9%）和 LR/NaHCO（3）（12.9%）。大约一半（49.5%）在 24 小时内添加胶体。尿液量是成功的主要指标（94.9%），而 22.7%使用其他监测器。大多数人（88.8%）认为他们的方案效果良好，69.8%的人认为该方案提供了适量的液体（24%--过多，7%--过少）。尽管有这种感觉，他们仍然认为在 55.1%的情况下，他们给予的液体多于公式，在 12.4%的情况下给予的液体少于公式，在 32.6%的情况下给予的液体正好。大约 1/3 使用口服复苏配方，81.8%的人认为口服配方适用于<15%TBSA 的烧伤。