Volume Overload of Fluid Resuscitation in Acutely Burned Patients Using Transpulmonary Thermodilution Technique

In recent years, transpulmonary thermodilution techniques (PICCO) offer an attractive and more ideal end point for fluid resuscitation. The study included 30 adult burned patients between 25 and 60% TBSA. The study group received fluid resuscitation guided by the PICCO. The control group resuscitated using Parkland formula, guided by traditional monitoring parameters. Fluid administration in the initial 72 hours after burn injury was significantly higher in the study group. Furthermore, it was difficult, perhaps even impossible, to achieve the goals of normovolemia and cardiac output normalization during the early postburn period. Nevertheless, the attempt to achieve them was associated with a significant tissue edema. Although PICCO is a very beneficial tool in the estimation of amounts of fluid resuscitation, the values of ideal end points need to be adjusted in burn patients. The traditional values of intrathoracic blood volume, extravascular lung water, and cardiac index are associated with significant tissue edema that can easily complicate sepsis in these immunocompromised patients. (J Burn Care Res 2013;34:349-354)