Usefulness of warm fluid in acute burn resuscitation: an experimental study in dogs

Severe burn injury, burn shock, and smoke inhalation injury in small animals. Part 2: diagnosis, therapy, complications, and prognosis

OBJECTIVE

To review the evaluation and treatment of patients suffering from severe burn injury (SBI), burn shock, and smoke inhalation injury. Potential complications and prognosis associated with SBI are also discussed.

DIAGNOSIS

Diagnosis of burn injury and burn shock is based on patient history and clinical presentation. Superficial burn wounds may not be readily apparent for the first 48 h whereas more severe wounds will be evident at presentation. Patients are diagnosed with local or SBI by estimating total body surface area involved using the 'Rule of Nines' or the Lund-Browder chart adapted from the human literature.

THERAPY

Patients suffering from SBI require immediate and aggressive fluid therapy. Burn wounds require prompt cooling to prevent progressive tissue damage. Due to significant pain associated with burn wounds and therapeutic procedures, multimodal analgesia is recommended. Daily wound management including hydrotherapy, topical medications, and early wound excision and grafting is necessary with SBI.

COMPLICATIONS

There are numerous complications associated with SBI. The most common complications include infections, hypothermia, intra-abdominal hypertension, and abdominal compartment syndrome.

PROGNOSIS

The prognosis of SBI in domestic animals is unknown. Based on information derived from human literature, patients with SBI and concomitant smoke inhalation likely have a worse prognosis than those with SBI or smoke inhalation alone.

In vitro evaluation of the efficacy of a veterinary dry heat fluid warmer

OBJECTIVES

To evaluate the efficacy of a veterinary dry heat fluid warmer on ambient and prewarmed crystalloid fluids and refrigerated packed red blood cells (pRBC).

DESIGN

Prospective in vitro study.

SETTING

University teaching hospital.

ANIMALS

None.

INTERVENTIONS

Ambient and prewarmed crystalloid fluids and refrigerated pRBC were delivered via a standard fluid administration set at various rates. A thermistor continuously monitored fluid outflow temperature with and without a dry heat veterinary fluid warmer (study device).

RESULTS

The outflow temperature was significantly higher with the study device as compared to control conditions for all fluids and rates tested. The maximum outflow temperature of approximately 35°C (95°F) occurred when the study device was applied to either ambient or prewarmed crystalloid fluids at 50 mL/h. In the study device trials, the outflow temperature of ambient crystalloid fluids ranged from 35.1° to 27.3°C (95.2° to 81.1°F) as the fluid rate increased from 50 to 999 mL/h. Control trials of prewarmed crystalloids produced outflow temperatures that rapidly approached ambient temperature. Addition of the study device to prewarmed crystalloids resulted in outflow temperatures that were similar to that of the corresponding ambient crystalloid trials. Control trials of refrigerated pRBC achieved ambient temperature at rates from 10 to 500 mL/h. With the study device, pRBC were maximally warmed to an outflow temperature of 35.8°C (96.4°F) at 100 mL/h.

CONCLUSION

Although the study device generated statistically significant increases in outflow temperature of crystalloid fluids and pRBC, the ability of the device to decrease the metabolic cost of fluid administration is limited to specific clinical scenarios. The use of prewarmed crystalloid fluids with or without the study device offers minimal benefit over ambient temperature crystalloids. Substantial warming of pRBC occurs during administration, even without use of the study device.