Yuan Kao1,2, El-Wui Loh3,4, Chien-Chin Hsu1,5, Hung-Jung Lin1,5,6, Chien-Cheng Huang1,7,8,9,10, Yun-Yun Chou11, Chieh-Chun Lien1, Ka-Wai Tam3,4,11,12,13,14. 1. Department of Emergency, Chi-Mei Medical Hospital, Tainan, Taiwan. 2. Graduate Institute of Medical Sciences, College of Health Science, Chang Jung Christian University, Tainan, Taiwan. 3. Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. 4. Department of Medical Research, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. 5. Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan. 6. Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan. 7. Department of Occupational Medicine, Chi-Mei Medical Hospital, Tainan, Taiwan. 8. Department of Geriatrics and Gerontology, Chi-Mei Medical Hospital, Tainan, Taiwan. 9. Department of Child Care and Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan. 10. Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan. 11. Shared Decision Making Resource Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. 12. Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. 13. Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 14. Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
Abstract
OBJECTIVES: Fluid resuscitation is the mainstay treatment to reconstitute intravascular volume and maintain end-organ perfusion in patients with severe burns. The use of a hyperosmotic or isoosmotic solution in fluid resuscitation to manage myocardial depression and increased capillary permeability during burn shock has been debated. We conducted a systematic review and meta-analysis to compare the efficacies of hyperosmotic and isoosmotic solutions in restoring hemodynamic stability after burn injuries. METHODS: PubMed, Embase, Cochrane Library, Scopus, and ClinicalTrials.gov registry were searched. Randomized control trials evaluating the efficacy and safety of hyperosmotic and isoosmotic fluid resuscitation in patients with burn injuries were selected. Eligible trials were abstracted and assessed for the risk of bias by two reviewers and results of hemodynamic indicators in the included trials were analyzed. RESULTS: Ten trials including 502 participants were published between 1983 and 2013. Compared with isoosmotic group, the hyperosmotic group exhibited a significant decrease in the fluid load (vol/% total body surface area [TBSA]/weight) at 24 hours postinjury, with a mean difference of -0.54 (95% confidence interval = -0.92 to -0.17). No differences were observed in the urine output, creatinine level, and mortality at 24 hours postinjury between groups. CONCLUSIONS: Hyperosmotic fluid resuscitation appears to be an attractive choice for severe burns in terms of TBSA or burn depth. Further investigation is recommended before conclusive recommendation.
OBJECTIVES: Fluid resuscitation is the mainstay treatment to reconstitute intravascular volume and maintain end-organ perfusion in patients with severe burns. The use of a hyperosmotic or isoosmotic solution in fluid resuscitation to manage myocardial depression and increased capillary permeability during burn shock has been debated. We conducted a systematic review and meta-analysis to compare the efficacies of hyperosmotic and isoosmotic solutions in restoring hemodynamic stability after burn injuries. METHODS: PubMed, Embase, Cochrane Library, Scopus, and ClinicalTrials.gov registry were searched. Randomized control trials evaluating the efficacy and safety of hyperosmotic and isoosmotic fluid resuscitation in patients with burn injuries were selected. Eligible trials were abstracted and assessed for the risk of bias by two reviewers and results of hemodynamic indicators in the included trials were analyzed. RESULTS: Ten trials including 502 participants were published between 1983 and 2013. Compared with isoosmotic group, the hyperosmotic group exhibited a significant decrease in the fluid load (vol/% total body surface area [TBSA]/weight) at 24 hours postinjury, with a mean difference of -0.54 (95% confidence interval = -0.92 to -0.17). No differences were observed in the urine output, creatinine level, and mortality at 24 hours postinjury between groups. CONCLUSIONS: Hyperosmotic fluid resuscitation appears to be an attractive choice for severe burns in terms of TBSA or burn depth. Further investigation is recommended before conclusive recommendation.