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21 - Fluid and Hemodynamic Monitoring in Burns

from Section 3 - Practical Use

Published online by Cambridge University Press:  11 April 2024

Alexandre Joosten
Affiliation:
University of California, Los Angeles
Maxime Cannesson
Affiliation:
University of California, Los Angeles
Robert G. Hahn
Affiliation:
Karolinska Institutet, Stockholm
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Summary

Severe burn injury induces an early and profound hypovolemia, rapidly followed by a systemic inflammatory response syndrome (SIRS) resulting in a distributive shock.

Cardiovascular consequences of severe burn injury are multiple including burn edema, burn shock, burn-associated cardiac injury and alteration of microcirculation

Hemodynamic targets of critically ill burn patients and goal-directed resuscitation therapy are the cornerstone of initial hemodynamic management.

This resuscitation is challenging with the risk of under- and over-resuscitation justifying an invasive hemodynamic monitoring.

Balanced crystalloids are the most commonly used fluids in severely burned patients; the use of albumin is controversial.

During the distributive phase, norepinephrine is often required 12 to 36 hours post-injury.

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Publisher: Cambridge University Press
Print publication year: 2024

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