Hydroxyethylstarch supplementation in burn resuscitation—A prospective randomised controlled trial

IntroductionHydroxyethylstarches (HES) are thought to be beneficial in trauma and major surgery management, due to their volume expansion and anti-inflammatory properties. This study examined the use of 6% (HES) in burn resuscitation.Methods26 adult patients with burns exceeding 15% total body surface area (TBSA) were randomised to either crystalloid (Hartmann's solution) or a colloid-supplemented resuscitation regime, where 1/3 of the crystalloid-predicted requirement was replaced by 6% HES.ResultsThere was no difference in age, gender or TBSA between the two groups. The median (95% CI) fluid volume/%TBSA received in the first 24 h was 307 ml and 263 ml for the crystalloid only and HES-supplemented group respectively (p = 0.0234, Mann–Whitney). Body weight gain within the first 24 h after injury was significantly lower in the HES-supplemented group 2.5 kg versus 1.4 kg respectively (p = 0.0039). The median (95% CI) serum C-reactive protein at 48 h after injury was 210(167–257) and 128(74–145) mg/L for the crystalloid only and HES-supplemented group respectively (p = 0.0001). Albumin–creatinine ratio per % burn (ACR, a marker of capillary leak) was lower in the HES-supplemented group at 12 h after burn (p = 0.0310).ConclusionsPatients treated with HES-supplemented resuscitation required less fluid, showed less interstitial oedema and a dampened inflammatory response compared to patients receiving isotonic crystalloid alone.