It is well known that shock is one of the main complications occurring during early stage of severe burn, and presently, ischemic/hypoxic damage of tissues and organs is still hard to be prevented by various fluid resuscitation regimens. Findings in recent years demonstrated that postburn cardiac damage occurs promptly and much earlier than any other organs. Application of measures to ameliorate cardiac damage may improve organ blood flow in liver, kidney, and intestines, and mitigate organ damage concomitant with fluid resuscitation according to Parkland formula. These facts suggest that cardiac damage occurring promptly at early stage of severe burn is one of the important factors leading to ischemia/hypoxia of tissues and organs, therefore,new resuscitation regimen including "volume replacement" plus "dynamic support" may conduct to more effective burn shock resuscitation, and reduce organ complications as a result of either insufficient or over fluid infusion.
Burns ; therapy ; Fluid Therapy ; Humans ; Resuscitation ; methods ; Shock, Traumatic ; therapy

Esophagectomy is one of the most complicated procedures. Satisfactory anesthesia not only ensures the safety in terms of low morbidity and mortality postoperatively, but also one of the potential factors relevant to long-term survival. Most of physicians, however, ignore the significance of anesthesia. This article focuses on the recent advances of anesthesia for esophagectomy in preoperative preparation for induction, rapid-sequence induction, one-lung ventilation, fluid management during surgery and postoperative early extubation and analgesia.
Analgesia ; Anesthesia ; methods ; Esophagectomy ; methods ; Fluid Therapy ; Humans

Albumins ; therapeutic use ; Fluid Therapy ; methods ; Humans ; Sepsis ; therapy

Hemorrhage is the second most common cause of death among trauma patients and almost half of the deaths occur within 24 hours after arrival. Damage control resuscitation is a new paradigm for patients with massive bleeding. It consists of permissive hypotension, hemostatic resuscitation and transfusion strategies, and damage control surgery. Permissive hypotension seems to have better results before the bleeding is controlled. The strategy of fluid resuscitation is minimizing crystalloid infusion and increasing early transfusion with a high ratio of fresh frozen plasma to packed red cells. Damage control surgery is done when the patient's condition is unfit for definitive surgery. Hemorrhage and contamination control with temporary abdominal closure is performed before transferring the patients to intensive care unit and the operating room for a permanent laparotomy.
Blood Transfusion ; Fluid Therapy ; methods ; Hemorrhage ; therapy ; Humans ; Isotonic Solutions

The aim of fluid resuscitation is to restore tissue perfusion, ameliorate cellular injury, increase tissue perfusion and oxygenation, and improve end-organ functions. Many researches in the field of fluid resuscitation strategy have been made in the last decade, but vigorous debate on optimal method of resuscitation still exists. The hypotensive resuscitation strategy is particularly applicable in patients with uncontrollable hemorrhage, whereas, it is uncertain whether the theory could be used in burn shock management. Resuscitation using both colloid and crystalloid has a better outcome in treating extensive burns and septic shock. Caution should be exercised when using higher concentrations of artificial colloid and lactated Ringer's solution, of which some adverse effects have been observed. Along with the increasing use of novel hemodynamics monitoring in intensive care, parameters including stroke volume variation (SVV), intrathoracic blood volume index (ITBVI), and cardiac index (CI) have been examined as indexes of resuscitation endpoint. However, further studies should be made when applying SVV, ITBVI, and CI in guiding fluid resuscitation in burns.
Burns ; complications ; Fluid Therapy ; methods ; Humans ; Shock ; etiology ; therapy

Although the outcome of burn patients has been improved, many aspects of management of severe burn patients remain controversial. Here we focus on the management of hypermetabolism and the resuscitation of respiratory function. Currently, the fluid resuscitation method shifts from insufficient fluid regimen to excessive fluid loading. The benefit of colloid infusion and restrictive blood transfusion need to be authenticated by further clinical trial, and the best form of fluid resuscitation has yet to be identified. The respiratory management of burn patients had been improved. Early tracheostomy, ventilation with low tidal volume and bronchoalveolar toilet are recommended. Many potential beneficial treatment strategies have been identified by recent research in the metabolic response to burn injury. Although immunomodulation therapy is promising, most of them are not clinical viable,and further clinical research is warranted.
Burns ; therapy ; Fluid Therapy ; Humans ; Respiration ; Resuscitation ; methods

Fluid therapy is one of the most controversial topics in perioperative management. Current perioperative fluid therapy is largely based on concepts developed restricted and liberal perioperative fluid administration in the late 1950s and 1960s. However, there are increasing reports of perioperative excessive intravascular volume leading to increased postoperative morbidity and mortality. The concept of individualized goal-directed therapy in surgical patients seems to be an important component for optimization of perioperative fluid management in high-risk surgical patients.
Fluid Therapy ; adverse effects ; methods ; Humans ; Perioperative Care

Parkland formula is the most widely used resuscitation formula in burn care. However, a growing number of disputes have been raised along with the development of medical technology, among which its total volume and composition of the fluid are the two foci. Firstly, Parkland formula may lead to an untoward phenomenon nicknamed "fluid creep", which may lead to complications such as abdominal compartment syndrome. Secondly, along with the deeper understanding of how permeability of blood vessels changes after burn injury, colloid is recommended to be given after the third 8 h post-burn. Additionally, controversy exists in the choice of different colloid solutions. The safety of different colloid solutions remains to be further elucidated. This article will deal with all of the above-mentioned problems.
Burns ; physiopathology ; therapy ; Fluid Therapy ; methods ; Humans ; Isotonic Solutions ; therapeutic use ; Resuscitation ; methods ; Treatment Outcome

As a newly developed technique for hemodynamic monitoring, pulse contour cardiac output (PiCCO) monitoring takes great advantages in guiding shock resuscitation and fluid administration. PiCCO has been used more and more in burn patients in recent years, however there is no clinic consensus on how to apply PiCCO monitoring, understand the significance of PiCCO monitored parameters, and guide the treatment using PiCCO monitored parameters in patients with severe burns. Based on the current literature and the experts' clinical experience, (2018 ) is now issued by the Burn and Trauma Branch of Chinese Geriatrics Society, aiming to provide practical guidance for its usage in clinic.
Burns ; therapy ; Cardiac Output ; Consensus ; Fluid Therapy ; Hemodynamics ; Humans ; Monitoring, Physiologic ; methods ; standards ; Resuscitation ; Shock ; therapy

As a newly developed technique for hemodynamic monitoring, pulse contour cardiac output (PiCCO) monitoring takes great advantages in guiding shock resuscitation and fluid administration. PiCCO has been used more and more in burn patients in recent years, however there is no clinic consensus on how to apply PiCCO monitoring, understand the significance of PiCCO monitored parameters, and guide the treatment using PiCCO monitored parameters in patients with severe burns. Based on the current literatures and the experts' clinical experience, (2018 ) is now issued by the Burn and Trauma Branch of Chinese Geriatrics Society, aiming to provide practical guidance for its usage in clinic.
Burns ; therapy ; Cardiac Output ; Consensus ; Fluid Therapy ; Hemodynamics ; Humans ; Monitoring, Physiologic ; methods ; standards ; Resuscitation ; Shock ; therapy