Resuscitation of severe thermal injury with hypertonic saline dextran: effects on peripheral and visceral edema in sheep

J Trauma. 2000 Nov;49(5):844-53. doi: 10.1097/00005373-200011000-00009.

Abstract

Background: Edema of tissue not directly injured by heat is a common complication after resuscitation of burn shock. Hypertonic 7.5% NaCl 6% dextran (HSD) infusion reduces early fluid requirements in burn shock, but the effects of HSD on peripheral and visceral tissue edema are not well-defined.

Methods: We measured the microcirculatory absorptive pressures of burned and nonburned skin and tissue water content of skin and other tissues in anesthetized sheep after 70% to 85% total body surface area scald and resuscitation. Fluid infusion was initiated 30 minutes after injury using 10 mL/kg HSD (n = 11) or lactated Ringer's (LR) (n = 12), with infusion rates titrated to restore and maintain preburn oxygen delivery (DO2). Thereafter, both groups received LR infusions as needed to maintain DO2 until the study's end at 8 hours. Colloid osmotic pressure was measured in plasma, and combined interstitial colloid osmotic and hydrostatic pressures were measured in skin.

Results: Both treatments successfully restored DO2, but fluid requirements were less with the HSD group than with the LR group (43+/-19 mL/kg vs. 194+/-38 mL/kg, respectively, p < 0.05). The peripheral and visceral tissue water contents at 8 hours postinjury until the end of the study in both burn groups were significantly higher than in nonburn controls. However, HSD-treated sheep had significantly less water content in the colon (less 28%), liver (less 9%), pancreas (less 55%), skeletal muscle (less 21%), and nonburned skin (less 12%) compared with LR-treated sheep (p < 0.05 for each). HSD-treated sheep maintained significantly higher (3 to 5 mm Hg) plasma colloid osmotic pressure than LR-treated sheep.

Conclusion: There were no observed differences in edema in burn skin between the two treatment groups. The early volume-sparing effect of HSD and reduction in tissue edema are likely attributed to an increased extracellular osmolarity and a better maintenance of the plasma oncotic pressure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Burns / complications*
  • Burns / metabolism
  • Burns / physiopathology
  • Burns / therapy*
  • Dextrans / therapeutic use*
  • Disease Models, Animal*
  • Edema / diagnosis
  • Edema / etiology*
  • Edema / therapy*
  • Female
  • Fluid Therapy / methods*
  • Hemodynamics
  • Hydrostatic Pressure
  • Isotonic Solutions / therapeutic use
  • Organ Size
  • Osmotic Pressure
  • Oxygen Consumption
  • Plasma Substitutes / therapeutic use*
  • Random Allocation
  • Resuscitation / methods*
  • Ringer's Lactate
  • Saline Solution, Hypertonic / therapeutic use*
  • Sheep

Substances

  • Dextrans
  • Isotonic Solutions
  • Plasma Substitutes
  • Ringer's Lactate
  • Saline Solution, Hypertonic