Randomized Trial of Fresh Frozen Plasma Versus Albumin in Acute Burn Resuscitation
Abstract
Large burns of the skin cause a response in the body whereby fluids leak out from the burns and blood vessels into the surrounding tissues. These losses need to be replaced with extra fluids, typically given intravenously (IV). This fluid replacement is called burn resuscitation. How these extra fluids are administered is very important and often debated. If given too little fluid, the body will become dehydrated, causing kidney failure, shock, and eventual death. If given too much fluid, the fluid will pool in other areas of the body like the lungs, tissues, and abdomen causing difficulty breathing, increasing risk of infections, respiratory failure, and death. The practice of giving too much fluid is termed over resuscitation. Patients who are over resuscitated have the risk of increased infections, complications, and death. Service Members burned during combat are at risk for over resuscitation due to long transport times, and strategies to limit this complication, and improve resuscitation practices in general, are needed to save lives. The goal of optimal fluid resuscitation is to achieve a balance with fluids going in and fluids going out of the body. Which type of fluid, and how much, have been a matter of debate for nearly a century. There are two types of fluids used in burn resuscitation. Crystalloids are salt-based solutions that mimic electrolyte composition of the body. These fluids are typically associated with getting IV fluids. Although crystalloids are cheap and plentiful, they last only 4 hours within the blood vessels, and then leak out into the tissues. Colloids are fluids that contain proteins (larger molecules), which enable the fluids to stay in the blood vessels for longer periods of time. Examples of colloids include fresh frozen plasma (FFP), the fluid in our blood vessels devoid of cells, and albumin, a molecule in the plasma. Colloids have been shown in numerous studies to decrease the amount of fluids required in burn resuscitation, thus decreasing complications of over resuscitation. However, controversy exists over which colloid, FFP or albumin, is better suited for burn resuscitation. In our burn center we have been using FFP in burn resuscitation for over a decade, with excellent results. We have been able to show that FFP decreases fluids given and prevents complications. Recent studies have shown that microscopic damage to the inner lining of the blood vessels (the endothelium) is largely responsible for the fluid losses seen in burn injury. Thus, stabilization of the endothelium may improve fluid resuscitation in burn patients, thereby improving outcomes. FFP has been shown to stabilize the endothelium in other patient populations. In our study, we seek to determine which colloid (FFP or albumin) is best at decreasing the amounts of fluids given, while also examining the effects on the endothelium. This research will pave the way for optimizing resuscitation strategies and improving health outcomes in military Service Members, and also in civilian and Veteran burn casualties.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110843
Entities
People
- Arek Wiktor
Organizations
- United States Army
- University of Colorado Denver