Relative hemodynamic effectiveness of whole blood and plasma expanders in burned patients.

In a series of nine fatally burned patients, hemodynamic and oxygen transport measurements were made before, during and after 56 administrations of 500 milliliters of whole blood or colloids and 1,000 milliliters of crystalloids. To enhance comparability, 38 of these studies were conducted at intervals on the same patient, the patient serving as his own control. The data indicate greater hemodynamic responses to colloids than to whole blood and greater responses to whole blood than to crystalloids when the latter was given at twice the volume as well as at four times the volume of the colloid. The data suggest that, in addition to replenishing salt and water, restoration of hemodynamic and oxygen transport variables may be accomplished by expansion of plasma volume with colloids and whole blood. Adequate nutrition is also needed for the increased metabolic needs of the burned patient. Without supplemental nutrition, high grade plasma proteins and tissue proteins may be expended as energy substrates; the lowering of plasma proteins tends to redistribute water from the plasma to the interstitial phase, which increases further the peripheral edema.