In the aftermath of a mass disaster, standard care methods for treatment of
burn injury will often not be available for all victims. A method of fluid
resuscitation for
burns that has largely been forgotten by contemporary
burn experts is enteral
resuscitation. We identified 12 studies with over 700 patients treated with enteral
resuscitation, defined as drinking or gastric infusion of
salt solutions, from the literature. These studies suggest that enteral
resuscitation can be an effective treatment for
burn shock under conditions in which the standard IV
therapy is unavailable or delayed, such as in mass disasters and combat casualties. Enteral
resuscitation of
burn shock was effective in patients with moderate (10-40% TBSA) and in some patients with more severe
injuries. The data suggests that some
hypovolemic burn and
trauma patients can be treated exclusively with enteral
resuscitation, and others might benefit from enteral
resuscitation as an initial alternative and a supplement to IV
therapy. A complication of enteral
resuscitation was
vomiting, which occurred less in children and much less when
therapy was initiated within the first postburn hour. Enteral
resuscitation is contra-indicated when the patient is in "peripheral
circulatory collapse". The optimal enteral
solution and regimen has not yet been defined, nor has its efficacy been tested against modern IV
resuscitation. The oldest studies used
glucose-free solutions of buffered isotonic and hypotonic saline. Studies that are more recent show benefit of adding
glucose to
electrolyte solutions similar to those used in the treatment of
cholera. If IV
therapy for mass casualty care is delayed due to logistical constraints, enteral
resuscitation should be considered.