Hsiao Kai Hsun, Kalanzi Joseph, Watson Stuart B, Murthy Srinivas, Movsisyan Ani, Kothari Kavita, Salio Flavio, Relan Pryanka
Emergency Medical Teams, Country Readiness Strengthening Department, World Health Organization, Geneva, Switzerland.
Department of Anaesthesia, Critical Care and Emergency Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Burns Open. 2024 Nov;8(4):None. doi: 10.1016/j.burnso.2024.100365.
Resource limitations in settings such as burn mass casualty incidents (MCIs) present challenges to the judicious fluid resuscitation required for major burns. Previous recommendations for burns care in MCIs have suggested certain adaptations from routine care, such as delaying intravenous (IV) fluid resuscitation until arrival at facility; using a fluid calculation formula that is independent of percentage of total body surface area (%TBSA) burned; or using fluid calculation formula based on time of arrival to first receiving facility rather than from time of injury, thus omitting 'catch-up' fluid.
To synthesize and assess certainty of evidence from resource-limited settings on the three adaptations to fluid resuscitation for patients with major burns in MCIs.
PubMed, EMBASE, CINAHL, and Cochrane Library were searched on 8 September 2023 with an update search on 8 July 2024. Primary quantitative studies in resource-limited settings meeting eligibility criteria as assessed by two reviewers were included. Where available, outcome effects for these adaptations compared to routine burns care were calculated. Evidence certainty was determined by GRADE.
Two eligible studies were identified from 544 search results. One study with 48 participants provided very uncertain evidence that delayed IV fluid resuscitation may increase acute kidney injury compared to prehospital resuscitation (OR 2.48, 95% CI 0.58-10.62). The other study with a cohort of 10 children provided very uncertain evidence that calculating fluid requirements based on time of arrival to first receiving facility, i.e. omitting 'catch-up' fluids, may maintain adequate urine output and be associated with no complications of fluid over- or under-resuscitation. There were no studies on use of a simplified %TBSA-independent fluid calculation formula.
There is very limited and uncertain evidence to inform on delayed IV fluid resuscitation, simplified %TBSA-independent formula, and omission of 'catch up' fluids for burns care in MCIs. Contextual factors, local values, preferences and feasibility also need to be considered.
在诸如烧伤大规模伤亡事件（MCI）等情况下，资源限制给严重烧伤所需的合理液体复苏带来了挑战。先前关于MCI中烧伤护理的建议提出了一些与常规护理不同的调整措施，例如将静脉输液（IV）复苏推迟到到达医疗机构后进行；使用与烧伤总面积百分比（%TBSA）无关的液体计算公式；或者根据到达首个接收机构的时间而非受伤时间来使用液体计算公式，从而省略“追赶”液体。
综合并评估来自资源有限环境的证据的确定性，这些证据涉及对MCI中严重烧伤患者液体复苏的三种调整措施。
于2023年9月8日对PubMed、EMBASE、CINAHL和Cochrane图书馆进行了检索，并于2024年7月8日进行了更新检索。纳入了由两名评审员评估符合资格标准的资源有限环境中的原发性定量研究。在可行的情况下，计算了这些调整措施与常规烧伤护理相比的结果效应。证据确定性由GRADE确定。
从544条检索结果中确定了两项符合条件的研究。一项有48名参与者的研究提供了非常不确定的证据，表明与院前复苏相比，延迟IV液体复苏可能会增加急性肾损伤（OR 2.48，95%CI 0.58 - 10.62）。另一项有10名儿童队列的研究提供了非常不确定的证据，表明根据到达首个接收机构的时间计算液体需求量，即省略“追赶”液体，可能维持足够的尿量，且与液体复苏过量或不足的并发症无关。没有关于使用简化的与%TBSA无关的液体计算公式的研究。
关于在MCI中烧伤护理时延迟IV液体复苏、简化的与%TBSA无关的公式以及省略“追赶”液体，有非常有限且不确定的证据。还需要考虑背景因素、当地价值观、偏好和可行性。
