Many strategies were proposed for fluid management in
burn patients with different composition containing
saline solution,
colloids, or plasma. The actual clinical use of volume replacement regimen in
burn patients in Europe was analysed by an international survey. A total of 187 questionnaires consisting of 20 multiple-choice questions were sent to 187 burn units listed by the European
Burn Association. The response rate was 43%. The answers came from a total of 20 European countries. Volume replacement is mostly exclusively with crystalloids (always: 58%; often: 28%). The majority still use fixed formulae: 12% always use the traditional Baxter formula, in 50% modifications of this formula are used. The most often used
colloid is
albumin (always: 17%, often: 38%), followed by HES (always: 4%, often: 34%).
Gelatins,
dextrans, and hypertonic saline are used only very rarely. Fresh frozen plasma (FFP) is given in 12% of the units as the
colloid of choice.
Albumin was named most often to be able to improve patients' outcome (64%), followed by HES (53%), and the exclusive use of crystalloids (45%). Central venous pressure (CVP) is most often used to monitor volume
therapy (35%), followed by the PiCCO-system (23%), and mixed-venous saturation (ScVO2; 10%). It is concluded that the kind of volume
therapy differs widely among European burn units. This survey supported that no generally accepted volume replacement strategy in
burn patients exists. New results, e.g. importance of goal-directed
therapy or data concerning use of
albumin in the
critically ill, have not yet influenced strategies of volume replacement in the
burn patient.