Role of HES 130/0.4 in resuscitation of patients with major burn injury: HES 130/0.4 IN MAJOR BURN INJURY

SUMMARY To investigate whether hydroxyethyl starch (HES) 130/0.4 can be used safely in the initial resuscitation (first 48 hours after admission) of burned patients, and more particularly whether its use in the early treatment of burns can reduce crystalloid overload. Burn patients with a total burn surface area over 30% were randomized to two groups receiving either crystalloids (Ringer's lactate) only or HES 130/0.4 (Voluven®, Fresenius Kabi, Bad Homburg, Germany) along with crystalloids for resuscitation. During the first 48 post-burn hours (PBH), fluid requirements were estimated using the Parkland formula and fluids were administered according to the study protocol. During the study, randomization had to be abandoned due to clinical and ethical reasons. The difference between ‘Fluid required’ and ‘Fluid given’ was recorded as either ‘Fluid saved’ or ‘Fluid excess’. Patients’ body weight and limb circumferences were measured as a guide to quantify the edema. Ten patients in the control group received Ringer's lactate solution only and 22 patients in the HES group received HES 130/0.4 plus Ringer's lactate solution for resuscitation. During the whole study period, mean fluid saving was 15.9% in the control group (n = 3) and 44.7% in the HES group (n = 20) (P = 0.0151). Mean fluid excess was 16.6% in the control group (n = 7) and 12.4% in HES group (n = 2) (P = 0.7120). By the end of 48 PBH, parameters related to tissue edema (mean rise in body weight and circumferences of burned and unburned areas) were significantly more favorable in the HES group (P = 0.0071, P < 0.0001 and P < 0.0001, respectively). Although the other management methods were the same in both groups, nine of 10 patients (90%) in the control group compared with 11 of 22 patients (50%) in the HES group died during their hospitalization (P = 0.0341). HES 130/0.4 appears to be a promising artificial plasma volume expander for burn resuscitation as compared with standard management. Further well-designed studies with large sample sizes are required to confirm these findings and explore the pharmacodynamic mechanisms involved.