A Preliminary Study On Fluid Resuscitation Protocol For The Shock Phase Post Severe Burn-blast Combined Injuries In Dogs

Objective Severshock and acute lung injury are two of the commonest complications post burn-blast combined injuries, which results in an inevitable dilemma on fluid resuscitation. This study aims at initially figuring out an optimal resuscitation protocol for sever burn-blast combined injuries induced shock in a canine model by comparing the treating effects of variant fluid volume.Method (Part Ⅰ) 24 beagle dogs were randomly assigned into 3 groups, namely, the Controlled(C) group, Decreased(D) group, Increased(I) group. The canine model were made in a reliable way testified in previous works elsewhere. Fluid resuscitation were started 1h post injury. Group C were resuscitated following Parkland formula exactly, while 20% volume were decreased or increased respectively in group D and group I. Hemodynamic parameters were determined pre and 4h,8h,24h,48h post injury. Blood gas analyses, blood routine and biochemical arrays were run in the mean while. Blood specimens were taken to run TNF-a, ICAM-1, VCAM-1 assays later. Urine of each dog was collected over the first 24hrs post injury. Lung tissue pathological changes were observed by HE and MPO staining. (Part Ⅱ) Another 24 beagle dogs were randomly assigned into 3 groups, namely, the Increased group 1(I1), Increased group 2(12), Increased group 3(13).10%,20%,30% additional fluid was given to group I1,12 and 13 as they were resuscitated with Parkland formula. The same determinations to Part I were set.Results Increasing fluid volume by 20% brought a remarkable effect in elevating urinary output. It also improved the cardiac output and preload, reduced the serum lactate level and depressed the inflammatory overreaction significantly when compared to the controlled group. However, decreasing the volume by 20% didn’t show these benefits. Serum lactate level was apparently higher in group I1 than in 12. Group 13 failed to bring further benefits in hemodynamic parameters, blood gas or inflammatory factors when compared to group 12. Instead, it made the urinary output undesirably high.Conclusion Resuscitating sever burn-blast combined injuries(35%TBSA full thickness burn + moderate blast injury) induced canine models with the Parkland formula calls for 20% additional fluid volume to achieve an optimal respond.