Excessive use of normal saline in managing traumatized patients in shock: a preventable contributor to acidosis.

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, People's Republic of China.
The Journal of trauma (Impact Factor: 2.96). 08/2001; 51(1):173-7. DOI: 10.1097/00005373-200107000-00033
Source: PubMed
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    ABSTRACT: Burn injury is damage to the skin or other body parts caused by extreme heat, flame, or contact with heated objects or chemicals. In United Kingdom (UK), it accounted for 175,000 emergency department attendances and 15,000 admissions. A further 250,000 burn patients were managed in the community by general practitioners or other healthcare professionals. A survey in 1998 showed that up to 58% of UK ambulance services had no specific treatment policy for burn patients. In Ireland and Australia, only 23% and 39% respectively, had employed the correct first aid burn management in studies conducted on their primary careers. Early burn management, both on scene and upon arrival to the hospital, are important to reduce the potential morbidity and mortality of burn victims. The initial management of burn, from removal of patients from zone of incident to the topical administration of cool water, has been shown to significantly reduce the extent of injury of burn patients. Further critical and timely assessment and management of these patients, pre-hospital and on arrival to emergency department, improve their chances of survival through adequate airway management and resuscitation. The need for emergency surgical procedure from emergency department to operating theatre should also be instituted when warranted without delay. Here, we review the pathophysiological rationale and evidence of practice behind each of these steps, from the first aid burn treatment to their assessment and resuscitation, and finally emergency procedure, together with their ancillary treatment, in practice.
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    ABSTRACT: Background The objective of this systematic review and meta-analysis was to assess the relationship between the chloride content of intravenous resuscitation fluids and patient outcomes in the perioperative or intensive care setting.Methods Systematic searches were performed of PubMed/MEDLINE, Embase and Cochrane Library (CENTRAL) databases in accordance with PRISMA guidelines. Randomized clinical trials, controlled clinical trials and observational studies were included if they compared outcomes in acutely ill or surgical patients receiving either high-chloride (ion concentration greater than 111 mmol/l up to and including 154 mmol/l) or lower-chloride (concentration 111 mmol/l or less) crystalloids for resuscitation. Endpoints examined were mortality, measures of kidney function, serum chloride, hyperchloraemia/metabolic acidosis, blood transfusion volume, mechanical ventilation time, and length of hospital and intensive care unit stay. Risk ratios (RRs), mean differences (MDs) or standardized mean differences (SMDs) and confidence intervals were calculated using fixed-effect modelling.ResultsThe search identified 21 studies involving 6253 patients. High-chloride fluids did not affect mortality but were associated with a significantly higher risk of acute kidney injury (RR 1·64, 95 per cent c.i. 1·27 to 2·13; P < 0·001) and hyperchloraemia/metabolic acidosis (RR 2·87, 1·95 to 4·21; P < 0·001). High-chloride fluids were also associated with greater serum chloride (MD 3·70 (95 per cent c.i. 3·36 to 4·04) mmol/l; P < 0·001), blood transfusion volume (SMD 0·35, 0·07 to 0·63; P = 0·014) and mechanical ventilation time (SMD 0·15, 0·08 to 0·23; P < 0·001). Sensitivity analyses excluding heavily weighted studies resulted in non-statistically significant effects for acute kidney injury and mechanical ventilation time.ConclusionA weak but significant association between higher chloride content fluids and unfavourable outcomes was found, but mortality was unaffected by chloride content.
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