1-s2.0-S030541791000152X-main

8/13/2019 1-s2.0-S030541791000152X-main

1/1

Response to Letter to the Editor

Fluid resuscitation in burns

Burns response to Letter to the Editor concerning Burnresuscitation: the results of the ISBI/ABA survey [1].

I appreciate the letter from Dr. Burd concerning my surveyrelated to practices of burn shock resuscitation around theworld. I agree with every idea that he presents. I was promptedto examine the practices of the initial burn resuscitation afterparticipating in the American BurnAssociations 2006 State of the Science Meeting where it became obvious that thereare many differences in our resuscitation practices. As statedin the conclusion of that meeting [2] the top ve topics forinvestigation were

(1) Dene the endpoints of burn shock resuscitation.(2) Develop a better understanding of the pathophysiology of

burn shock edema.(3) Determine the cause of uid creep.(4) Develop an oral resuscitation protocol.(5) Perform a multicenter trial with an agent that reduces the

capillary leak of burn shock (i.e. Vitamin C).

Thegoalof theISBI/ABAsurveywas to documenthow muchdifference really existed, and to my surprise; the differenceswere more marked than expected. As a rule, when there aremultiple ways of performing a task, then there is no best wayto perform that task. None of the resuscitation formulas workwell and attention to detail to the patients response is alsoinadequate. More research is needed to improve our resuscita-tion techniques. We need to work to develop better ways toinitiate resuscitation, identify physiologic endpoints and thenimprove our responses to those changes. Clearly, multi-centertrials to address these issues would be the best way to resolveresuscitation problems.

Conict of interest statement

There is no conict of interest related to this response to theLetter to the Editor.

r e f e r e n c e s

[1] Greenhalgh DG. Burn resuscitation: the results of the ISBI/ABA survey. Burns 2010;36:17682.

[2] Greenhalgh DG. Burn resuscitation. J Burn Care Res2007;28:55565.

David G. Greenhalgh *Shriners Hospitals for Children Northern California and UC Davis

Medical Center, 2425 Stockton Boulevard, Sacramento,CA 95817, United States

*Tel.: +1 916 453 2000; fax: +1 916 453 2352

E-mail address: david.greenhalgh@ucdmc.ucdavis.edu

25 May 2010

0305-4179/$36.00# 2010 Elsevier Ltd and ISBI. All rights reserved.

doi:10.1016/j.burns.2010.05.022

Letter to the Editor

Fluid resuscitation in burns

The results of the survey by David G. Greenhalgh wereinteresting if not predictable [1]. The wide range of clinicalpractice reectsthe reality that there is no one way to achievesatisfactory resuscitation. This can be a restatement of Dr.Greenhalghs conclusion that the large variance in formulasand uids tell us that no protocol is perfect; in effect everyprotocol hasthe capacity to achieve a perfectresultbecause itwould be unethical to use it if it was consistently bad.

And this underlines the fundamental challenge in burnsresuscitation; we are dealing with individuals not populations.Formulae are for populations and the essential point is how toquickly, smoothly and reliably tailor the resuscitation to theindividual patient. This challenge becomes even greater whenthere has been a delay in beginning resuscitation or where thepatient has a medical co-morbidity that can complicate theresuscitation process. I certainly agree that better end pointsto resuscitation need to be developed but perhaps of greaterimportance are the parameters that are measured during resuscitation and the response, in terms of uid infusion, todeviations outside a pre-established range of values. Anexample of this is described in Latensers review article [2]which contains Safes algorithm for resuscitation of adult

b u r n s 3 6 ( 2 0 1 0 ) 1 3 1 6 1 3 2 1

a va i l ab l e a t www.sc i en ced i r ec t . com

journal homepage: www.elsevier.com/locate/burns