Randomized Trial of Efficacy of Crystalloid and Colloid Resuscitation on Hemodynamic Response and Lung Water Following Thermal Injury

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Abstract
To assess the effects of crystalloid and colloid resuscitation on hemodynamic response and on lung water following thermal injury, 79 patients were assigned randomly to receive lactated Ringer''s solution or 2.5% albumin-lactated Ringer''s solution. Crystalloid-treated patients required more fluid for successful resuscitation than did those receiving colloid solutions (3.81 vs. 2.98 ml/kg body wt/% body surface burn, P < 0.01). In study phase 1 (29 patients), cardiac index and myocardial contractility (ejection fraction and mean rate of internal fiber shortening, Vcf) were determined by echocardiography during the first 48 h postburn. Cardiac index was lower in the 12-24-h postburn interval in the crystalloid group, but this difference between treatment groups had disappeared by 48 h postburn. Ejection fractions were normal throughout the entire study, while Vcf was supranormal (P < 0.01 vs. normals) and equal in the 2 resuscitation groups. In study phase 2 (50 patients), extravascular lung water and cardiac index were measured by a standard rebreathing technique at least daily for the 1st postburn wk. Lung water remained unchanged in the crystalloid-treated patients (P > 0.10), but progressively increased in the colloid-treated patients over the 7-day study (P < 0.0001). The measured lung water in each treatment group was significantly different from one another (P < 0.001). Cardiac index increased progressively and identically in both treatment groups over the study period (P < 0.01). The existence of myocardial depression during postburn resuscitation is refuted. Hypercontractile left ventricular performance is documented. The addition of colloid to crystalloid resuscitation fluids produces no long lasting benefit on total body blood flow, and promotes accumulation of lung water when edema fluid is being reabsorbed from the burn wound.