1. 2.1.5 Is anti-shock therapy needed during MEBT/MEBO treatment and How to calculate the volume of fluid resuscitation?
    • 2010/10/25 10:43:01
    Severe and extraordinarily severe burns patients need routine anti-shock therapy by fluid resuscitation. Though systemic anti-shock therapy in BRT&MEBT/MEBO treatment is basically the same as that in conventional surgical method of burns treatment, the differences in wound treatment of MEBT/MEBO and conventional method characterize the unique specialties and requirements of MEBT/MEBO, e.g.: one of the significant differences is in the transepidermal water loss (TEWL) by evaporation: The TEWL of MEBO group is 1.191.75 times higher than that of the normal skin (i.e. 0.4ml0.62ml/h/%)the TEWL of SD-Ag group is 19.05 times higher than that of the normal skin (i.e. 6.4ml/h/%). Therefore, the anti-shock therapy by fluid resuscitation should be applied according to the wound condition and symptoms of the patients in clinic, avoiding over-dosage and over-speed during the fluid resuscitation. 
    Calculation of the fluid resuscitation in the anti-shock therapy:
    Composition of fluid resuscitationthe ratio between crystal and colloid is 11, the composition of colloid is 1/2 of plasma and 1/2 of plasma substitute or 3/4 plasma and 1/4 whole blood if possible. 
    The volume of the fluid resuscitationrequired volume in shock stage (ml/d)=physiologically required volume (ml)1%TBSA1mlbody weight (kg)]UV (ml/h)/ body weight (kg). PS: UV= urinary volume.
    Speed of the fluid resuscitationThe speed of the fluid resuscitation in the first 24 hours should not be too high. Half or 3/5 of the total volume required per day should be finished within the former 12 hours, and accelerate the speed properly according to the cardiac and renal conditions for the latter 12 hours. Equilibrate transfusion could be performed for the second 24hours. The volume and speed should be determined in terms of the urinary volume and shock symptoms for the third 24 hours. The total volume can be reduced by 1/3 if there are improved shock symptoms or no shock occurs with normal urinary volume (1ml/h/kg of body weight).