Problem based management in delayed presented burned in Cipto Mangunkusumo General Hospital, Jakarta

Yefta Moenadjat, Dina Dwi Mulia


Introduction. Burn injured victims managed in Burn Unit of dr Cipto Mangunkusumo General Hospital, Jakarta (RSCM) is dominated by delayed presentation and categorized as the difficult cases. Though had been rescued before being referred to our unit, these cases were characterized by massive edema and minimal to nil responsiveness to standard burn fluid resuscitation, and were followed by high mortality.

Method. A retrospective study run on those resuscitated in period of 1998–2010 using different protocols aimed to find out the most suitable formula to treat these subjects. Pediatric–, chemical– and electrical burns was excluded. Hydration status, hemodynamic– and perfusion indices, complication(s), mortality as well as survival days were variables of interest subjected to statistical analysis. Significance met if p <0.05.

Results. Out of 1768 subjects managed, 659 were enrolled in the study. Mortality in those treated in first period was 44.9% with survival 10.10 ± 7.39 pbd, in the second period was 54.6% with survival 8.55 ± 6.39 pbd, in the third period was 43.4% with survival 11.34 ± 7.34 pbd, and the last period was 13.4% with survival 18.78 ± 6.32 pbd.

Conclusion. In these characteristics, perfusion targeted resuscitation showed to be superior than volume oriented. Even though mortality remains the problem, survival days markedly increased.

Keywords: delayed presented burned, balanced fluid resuscitation, mortality, survival days

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Pham TN, Cancio LC, Gibran NS. American Burn Association practice guidelines burn shock resuscitation. J Burn Care Res. 2008;29(1):257–66.

Saffle J. Practice guidelines for burns care. J Burn Care Rehabil. 2001;Suppl:S1–S69.

Cartotto RC, Innes M, Musgrave M a, Gomez M, Cooper AB. How well does the Parkland formula estimate actual fluid resuscitation volumes? J Burn Care Rehabil. 2000;23(4):258–65.

Latenser BA. Critical care of the burn patient: the first 48 hours. Crit Care Med. 2009;37(10):2819–26.

Pruitt BA. Protection from Excessive Resuscitation: “Pushing the Pendulum Back”. J Trauma 1981;21:690–2

Saffle JR. The Phenomenon of “Fluid Creep” in Acute Burn Resuscitation. J Burn Care Res J Burn Care Res 2007;28:382–95.

Kumar P. Grading of severity of the condition in burn patients by serum protein and albumin/globulin studies. Ann Plast Surg. 2010;65(1):74–9

Moenadjat Y, Rehatta NM. Clinical Parameter in the Assessment of Critical Burned Injury. J Ilmu Bedah Indones. 2012;40(1–2):27–34.

Faucher LD, Conlon KM. Practice guidelines for deep venous thrombosis prophylaxis in burns. J Burn Care Res. 2007;28(5):661–3.

Moenadjat Y, Siregar NC, Wanandi SI, Sadikin M. Endothelial Dysfunction in Critical Burns: A Histomorphological Study. J Imu Bedah Indones. 2013;41(1):29–36.

Moenadjat Y. Desertasi: Disfungsi Endotel dan Penguraian Endothelial Junction pada Luka Bakar Kritis dan Non Kritis. Universitas Indonesia; 2012.

Petersen LJ, Pedersen JL, Skov PS, Nielsen HJ, Kehlet H. Histamine is not released in acute thermal injury in human skin in vivo: a microdialysis study. Inflamm Res. 2009;58)7):395–9.

Horton JW. Free radicals and lipid peroxidation mediated injury in burn trauma: The role of antioxidant therapy. Toxicology. 2003;189(1–2):75–88.

Allgöwer M, Schoenenberger GA, Sparkes BG. Pernicious effectors in burns. Burns. 2008;34(Suppl.):1–55.

Hirth D, McClain SA, Singer AJ, Clark RAF. Endothelial necrosis at 1 hour postburn predicts progression of tissue injury. Wound Repair Regen. 2013;21(4):563–70.

Huang Y, Yan B, Yang Z. Clinical study of a formula for delayed rapid fluid resuscitation for patients with burn shock. Burns. 2005;31(5):617–22.

Duncan R, Dunn K. Physiological responses to burn injury and resuscitation protocols for adult major burns. Ch.6. In: Stone C. The Evidence for Plastic Surgery. Castle Hill Barns, UK: Tfm Publishing; 2008;p.63–92.

Lippi G, Ippolito L, Cervellin G. Disseminated intravascular coagulation in burn injury. Semin Thromb Hemost 2010;36(4):429–36.

Motterlini R, Kerger H, Green CJ, Winslow RM, Intaglietta M. Depression of endothelial and smooth muscle cell oxygen consumption by endotoxin. Am J Physiol. 1998;275(3 Pt 2):H776–82.

Demling RH. The Study of Burn Wound Edema Using Dichromatic Absorptiometry. J Trauma. 1978;18(2):124–8.

Demling RH. The burn edema process: current concepts. J Burn Care Rehabil. 2005;26(3):207–27.

Baxter CR, Shires T. Physiological Response To Crystalloid Resuscitation of Severe Burns. Ann N Y Acad Sci. 1968;150(3):874–94.

Baxter CR. Problems and complications of burn shock resuscitation. Surg Clin North Am. 1978;58(6):1313–22.

Matsuda Y, Sakurai T, Iino M, Nakayama K. Comparative study on the effects of acetated Ringer"s solution, lactated Ringer"s solution, Ringer"s solution, and 5% glucose–acetated Ringer’s solution on canine hemorrhagic shock. J Anesth. 1994;8(3):326–333.

Atiyeh BS, Dibo SA, Ibrahim AE, Zgheib ER. Acute burn resuscitation and fluid creep: It is time for colloid rehabilitation. Ann Burns Fire Disasters. 2012;25(2):59–65.

Ragaller MJ, Theilen H, Koch T. Volume replacement in critically ill patients with acute renal failure. J Am Soc Nephrol. 2001;12 Suppl 1:S33–9.

MutterTC, RuthCA, DartAB. Hydroxyethyl starch (HES) versus other fluid therapies: effects on kidney function. Cochrane Database of Systematic Reviews 2013, Issue 7. Art.No.: CD007594. DOI: 10.1002/14651858.CD007594.pub3.

Myburgh, JA, Mythen M. Resuscitation Fluids. NEJM. 2013;369:1243–51.

Gosling P. Salt of the earth or a drop in the ocean? A pathophysiological approach to fluid resuscitation. Emerg Med J. 2003;20(4):306–15.

Jaskille AD, Jeng JC, Sokolich JC, Lunsford P, Jordan MH. Repetitive Ischemia–Reperfusion Injury: A Plausible Mechanism for Documented Clinical Burn–Depth Progression After Thermal Injury. J Burn Care. 2007;28:13–20.

Tanaka H, Matsuda T, Miyagantani Y, Yukioka T, Matsuda H, Shimazaki S. Reduction of resuscitation fluid volumes in severely burned patients using ascorbic acid administration: a randomised, prospective study. Arch Surg. 2000;135:326–31.

Kahn SA, Beers RJ, Lentz CW. Resuscitation after severe burn injury using high–dose ascorbic acid: A retrospective review. J Burn Care Res. 2011;32(1):110–7.

Wu G, Zhuang M, Fan X, Hong X, Wang K, Wang H, Blood transfusions in severe burn patients: Epidemiology and predictive factors. Burns. 2016;42(8):1721–7.

Palmieri TL, Greenhalgh DG. Blood Transfusion in Burns: What Do We Do? J Burn Care Rehabil. 2004;25:71–5.

Ravishankar J, Jagannathan SY, Arumugam P, Chitra M. Evaluating the appropriateness of blood component utilization in burns patients. Int J Res Med Sci. 2016;4(12):5364–71.

Moenadjat Y, Madjid A, Siregar P, Wibisono L. Keseimbangan Air–Elektrolit dan Asam–Basa. Ed.3. Jakarta: Balai Penerbit FKUI; 2012.

Napolitano LM, Kurek S, Luchette F. Clinical practice guideline: red blood cell transfusion in adult trauma and critical care. Crit Care Med. 2009;37(12):3124–57.

Cochran A, Edelman LS, Saffle JR, Morris SE. The Relationship of Serum Lactate and Base Deficit in Burn Patients to Mortality. J Burn Care Res. 2007;28:231–40.

Glas GJ, Levi M, Schultz MJ. Coagulopathy and its management in patients with severe burns. J Thromb Haemost. 2016;14:865–74.

Jones LM, Deluga NG, Bhatti P, Scrape SR, Bailey JK, Coffey RA. TRALI following fresh frozen plasma resuscitation from burn shock. Burns. 2016;43(2):397–402.


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