Adapted approaches to initial fluid management of patients with major burns in resource-limited settings: A systematic review
Background: Resource limitations in settings such as burn mass casualty incidents (MCIs) present challenges to the judicious fluid resuscitation required for major burns. Previous recommendations for burns care in MCIs have suggested certain adaptations from routine care, such as delaying intravenou...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-11-01
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| Series: | Burns Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468912224000531 |
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| author | Kai Hsun Hsiao Joseph Kalanzi Stuart B Watson Srinivas Murthy Ani Movsisyan Kavita Kothari Flavio Salio Pryanka Relan |
| author_facet | Kai Hsun Hsiao Joseph Kalanzi Stuart B Watson Srinivas Murthy Ani Movsisyan Kavita Kothari Flavio Salio Pryanka Relan |
| author_sort | Kai Hsun Hsiao |
| collection | DOAJ |
| description | Background: Resource limitations in settings such as burn mass casualty incidents (MCIs) present challenges to the judicious fluid resuscitation required for major burns. Previous recommendations for burns care in MCIs have suggested certain adaptations from routine care, such as delaying intravenous (IV) fluid resuscitation until arrival at facility; using a fluid calculation formula that is independent of percentage of total body surface area (%TBSA) burned; or using fluid calculation formula based on time of arrival to first receiving facility rather than from time of injury, thus omitting ‘catch-up’ fluid. Objectives: To synthesize and assess certainty of evidence from resource-limited settings on the three adaptations to fluid resuscitation for patients with major burns in MCIs. Methods: PubMed, EMBASE, CINAHL, and Cochrane Library were searched on 8 September 2023 with an update search on 8 July 2024. Primary quantitative studies in resource-limited settings meeting eligibility criteria as assessed by two reviewers were included. Where available, outcome effects for these adaptations compared to routine burns care were calculated. Evidence certainty was determined by GRADE. Results: Two eligible studies were identified from 544 search results. One study with 48 participants provided very uncertain evidence that delayed IV fluid resuscitation may increase acute kidney injury compared to prehospital resuscitation (OR 2.48, 95% CI 0.58–10.62). The other study with a cohort of 10 children provided very uncertain evidence that calculating fluid requirements based on time of arrival to first receiving facility, i.e. omitting ‘catch-up’ fluids, may maintain adequate urine output and be associated with no complications of fluid over- or under-resuscitation. There were no studies on use of a simplified %TBSA-independent fluid calculation formula. Conclusions: There is very limited and uncertain evidence to inform on delayed IV fluid resuscitation, simplified %TBSA-independent formula, and omission of ‘catch up’ fluids for burns care in MCIs. Contextual factors, local values, preferences and feasibility also need to be considered. |
| format | Article |
| id | doaj-art-833896cb03b44156957264e6c73916ab |
| institution | Kabale University |
| issn | 2468-9122 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Burns Open |
| spelling | doaj-art-833896cb03b44156957264e6c73916ab2024-11-13T04:30:14ZengElsevierBurns Open2468-91222024-11-0184100365Adapted approaches to initial fluid management of patients with major burns in resource-limited settings: A systematic reviewKai Hsun Hsiao0Joseph Kalanzi1Stuart B Watson2Srinivas Murthy3Ani Movsisyan4Kavita Kothari5Flavio Salio6Pryanka Relan7Emergency Medical Teams, Country Readiness Strengthening Department, World Health Organization, Geneva, Switzerland; Corresponding author at: Emergency Medical Teams, Country Readiness Strengthening Department, World Health Organization, Avenue Appia 20, CH-1211 Geneva, Switzerland.Department of Anaesthesia, Critical Care and Emergency Medicine, College of Health Sciences, Makerere University, Kampala, UgandaCanniesburn Plastic Surgery and Burns Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom of Great Britain and Northern IrelandFaculty of Medicine, University of British Columbia, Vancouver, CanadaConsultant to the Methods and Standards Team, World Health Organization, Geneva, SwitzerlandConsultant to Library and Digital Information Networks, World Health Organization, Geneva, SwitzerlandEmergency Medical Teams, Country Readiness Strengthening Department, World Health Organization, Geneva, SwitzerlandEmergency Medical Teams, Country Readiness Strengthening Department, World Health Organization, Geneva, SwitzerlandBackground: Resource limitations in settings such as burn mass casualty incidents (MCIs) present challenges to the judicious fluid resuscitation required for major burns. Previous recommendations for burns care in MCIs have suggested certain adaptations from routine care, such as delaying intravenous (IV) fluid resuscitation until arrival at facility; using a fluid calculation formula that is independent of percentage of total body surface area (%TBSA) burned; or using fluid calculation formula based on time of arrival to first receiving facility rather than from time of injury, thus omitting ‘catch-up’ fluid. Objectives: To synthesize and assess certainty of evidence from resource-limited settings on the three adaptations to fluid resuscitation for patients with major burns in MCIs. Methods: PubMed, EMBASE, CINAHL, and Cochrane Library were searched on 8 September 2023 with an update search on 8 July 2024. Primary quantitative studies in resource-limited settings meeting eligibility criteria as assessed by two reviewers were included. Where available, outcome effects for these adaptations compared to routine burns care were calculated. Evidence certainty was determined by GRADE. Results: Two eligible studies were identified from 544 search results. One study with 48 participants provided very uncertain evidence that delayed IV fluid resuscitation may increase acute kidney injury compared to prehospital resuscitation (OR 2.48, 95% CI 0.58–10.62). The other study with a cohort of 10 children provided very uncertain evidence that calculating fluid requirements based on time of arrival to first receiving facility, i.e. omitting ‘catch-up’ fluids, may maintain adequate urine output and be associated with no complications of fluid over- or under-resuscitation. There were no studies on use of a simplified %TBSA-independent fluid calculation formula. Conclusions: There is very limited and uncertain evidence to inform on delayed IV fluid resuscitation, simplified %TBSA-independent formula, and omission of ‘catch up’ fluids for burns care in MCIs. Contextual factors, local values, preferences and feasibility also need to be considered.http://www.sciencedirect.com/science/article/pii/S2468912224000531BurnsDisastersFluid therapyIntravenous fluidMass casualty incidentsResource-limited settings |
| spellingShingle | Kai Hsun Hsiao Joseph Kalanzi Stuart B Watson Srinivas Murthy Ani Movsisyan Kavita Kothari Flavio Salio Pryanka Relan Adapted approaches to initial fluid management of patients with major burns in resource-limited settings: A systematic review Burns Open Burns Disasters Fluid therapy Intravenous fluid Mass casualty incidents Resource-limited settings |
| title | Adapted approaches to initial fluid management of patients with major burns in resource-limited settings: A systematic review |
| title_full | Adapted approaches to initial fluid management of patients with major burns in resource-limited settings: A systematic review |
| title_fullStr | Adapted approaches to initial fluid management of patients with major burns in resource-limited settings: A systematic review |
| title_full_unstemmed | Adapted approaches to initial fluid management of patients with major burns in resource-limited settings: A systematic review |
| title_short | Adapted approaches to initial fluid management of patients with major burns in resource-limited settings: A systematic review |
| title_sort | adapted approaches to initial fluid management of patients with major burns in resource limited settings a systematic review |
| topic | Burns Disasters Fluid therapy Intravenous fluid Mass casualty incidents Resource-limited settings |
| url | http://www.sciencedirect.com/science/article/pii/S2468912224000531 |
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