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Überinfusion von Verbrennungsopfern: häufig und schädlich

Over infusion in burn victims: frequent and injurious

  • Konzepte - Qualitätsmanagement
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Zusammenfassung

Hintergrund

Schwerbrandverletzte (mehr als 20% verbrannter Körperoberfläche bei Erwachsenen) weisen in der ersten Phase (8–48 h) einen durch das massive Kapillarleck bedingten Verbrennungsschock auf, der einer Infusionstherapie bedarf, um die Hämodynamik wieder herzustellen. Bis in die 80er Jahre stellte eine unzureichende Flüssigkeitstherapie (Unterinfusion) die Haupttodesursache von Verbrennungspatienten dar. Seither ist die übermäßige Flüssigkeitstherapie (Überinfusion) zu einer beachtenswerten Quelle von Komplikationen geworden: abdominales Kompartmentsyndrom, Entlastungsschnitte (Escharotomie), Verschlechterung des Gasaustauschs, Verlängerung der künstlichen Beatmung und des Spitalaufenthalts. Die Überinfusion hat Ende der 90er Jahre begonnen, wo innerhalb der ersten 24 h Flüssigkeitsmengen zugeführt wurden, die weit über den 4 ml/kg/% BSA („burn surface area“) der Parkland-Formel lagen.

Ziel

Dieser Beitrag analysiert die Faktoren, welche zu einer Überinfusion führen können und zeigt Möglichkeiten, dem durch eine strikte Kontrolle der präklinischen Infusionstherapie sowie durch eine permissive Hypovolämie vorzubeugen.

Abstract

Background

Major burns are characterized by an initial capillary leak, which requires fluid resuscitation for hemodynamic stabilization. While under resuscitation was the major cause of death until the 1980s, over resuscitation has become an important source of complications, including abdominal compartment syndrome, escharosis, impaired gas exchange with prolonged mechanical ventilation and hospital stay. Fluid over infusion started in the 1990s with an increasing proportion of the fluid delivered within the first 24 h being well above the 4 ml/kg/% burn surface area (BSA) according to the Parkland formula. The first alerts were published in the form of case reports of increased mortality due to abdominal compartment syndrome and respiratory failure.

Objective

This paper analyses the causes of this fluid over infusion and the ways to prevent it, which include rationing prehospital fluid delivery, avoiding early administration of colloids and prevention by permissive hypovolemia.

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Compliance with Ethics Guidelines

 

Conflict of interest

B. Michaeli, P.-N. Carron, J.-P. Revelly, M.-A. Bernath, C. Schrag and M.M. Berger declare that they have no conflict of interest.

This article does not contain any studies with human or animal subjects.

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Authors and Affiliations

  1. Service d’Anesthésiologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Schweiz

    B. Michaeli & M.-A. Bernath

  2. Service des Urgences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Schweiz

    P.-N. Carron

  3. Service de Médecine Intensive Adulte et Centre des Brûlés, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Schweiz

    J.-P. Revelly &  M.M. Berger

  4. Medizinische Intensivstation, Kantonssptial St. Gallen, St. Gallen, Schweiz

    C. Schrag

Authors
  1. B. Michaeli
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  2. P.-N. Carron
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  3. J.-P. Revelly
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  4. M.-A. Bernath
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  5. C. Schrag
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  6. M.M. Berger
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Correspondence to M.M. Berger.

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Michaeli, B., Carron, PN., Revelly, JP. et al. Überinfusion von Verbrennungsopfern: häufig und schädlich. Notfall Rettungsmed 16, 42–47 (2013). https://doi.org/10.1007/s10049-012-1588-3

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  • DOI: https://doi.org/10.1007/s10049-012-1588-3

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