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    Plasma for burn shock resuscitation: is it time to go back to the future?

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    Author
    Gurney, J.M.
    Kozar, R.A.
    Cancio, L.C.
    Date
    2019
    Journal
    Transfusion
    Publisher
    Blackwell Publishing Inc.
    Type
    article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1111/trf.15243
    Abstract
    Patients with burn shock can be challenging to resuscitate. Burn shock produces a variety of physiologic derangements: Patients are hypovolemic from volume loss, have a increased systemic vascular resistance, and may have a depressed cardiac output depending on the extent of the thermal injury. Additionally, the burn wound produces a significant inflammatory cascade of events that contributes to the shock state. Fluid resuscitation is foundational for the initial treatment of burn shock. Typical resuscitation is with intravenous lactated Ringer's in accordance with well-established formulas based on burn wound size. In the past century, as therapies to treat thermal injuries were being developed, plasma was the fluid used for burn resuscitation; in fact, plasma was used in World War II and throughout the 1950s and 1960s. Plasma was abandoned because of infectious risks and complications. Despite huge strides in transfusion medicine and the increased safety of blood products, plasma has never been readopted for burn resuscitation. Over the past 15 years, there has been a paradigm shift in trauma resuscitation: Less crystalloid and more blood products are used; this strategy has demonstrated improved outcomes. Plasma is a physiologic fluid that stabilizes the endothelium. The endotheliopathy of trauma has been described and is mitigated by transfusion strategies with a 1:1 ratio of RBCs to plasma. Thermal injury also results in endothelial dysfunction: the endotheliopathy of burns. Plasma is likely a better resuscitation fluid for patients with significant burn wounds because of its capability to restore intravascular volume status and treat the endotheliopathy of burns.
    Keyword
    burn shock
    Resuscitation
    Plasma
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85064262615&doi=10.1111%2ftrf.15243&partnerID=40&md5=a803200c4f19f76a8f7bc80c71f8b9ce; http://hdl.handle.net/10713/10211
    ae974a485f413a2113503eed53cd6c53
    10.1111/trf.15243
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