American journal of surgery
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This study has reviewed the results of burn care in a burn center between 1978 and 1986. The total population included 1,458 patients. Mean burn size was 19 percent total body surface area, mean patient age was 24.4 years, and overall survival rate was 92 percent. ⋯ Since that, the survival rate increased to 77 percent and mean length of hospital stay increased to 35.2 days. The early burn mortality rate remained nearly constant during the period of study (17 percent during the first half of the study and 16 percent during the second half), but the late mortality rate decreased significantly during the second half of the study (24 percent versus 8 percent, p less than 0.01). These data demonstrate increased survival rates after major thermal injury due to improvements in prevention and treatment of sepsis and other late complications of thermal injury.
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Comparative Study
Beneficial effects of a hypertonic solution for resuscitation in the presence of acute hemorrhage.
Crystalloid solutions such as Ringer's lactate have become the standard for initial volume replacement after hemorrhage. Although the relative merits of blood, colloid, and crystalloid have been extensively studied, little attention has been directed toward determining the optimal composition of the crystalloid solution. Based on the beneficial properties of hypertonic lactated saline solution in burn resuscitation, we have extended its use to acute hemorrhage. ⋯ The hypertonic lactated saline solution group required less fluid to restore and maintain cardiac output and blood pressure while maintaining better urine output. Although the Ringer's lactate solution group had increased shunt function indicative of pulmonary dysfunction, the shunt function in the hypertonic lactated saline solution group did not differ from that in the control group. Serum sodium and osmolality values were higher in the hypertonic lactated saline solution group, but at no time did they approach toxic levels.