Fluid Resuscitation in Burn Patients

Clearance of Acetate During Fluid Resuscitation of Critically Ill Burn Patients: The CARE Trial.

Balanced solutions with low chloride concentration could represent an alternative to high chloride concentration solutions. Such balanced solutions contain other acid as buffers (i.e. acetate and/or gluconate). However, acetate has been associated with alteration of cardiac function when used as buffer in dialysate when high acetate concentrations are used and could promote the development of metabolic acidosis if it accumulates. Therefore, the safety of such solutions remains poorly explored. Because critically ill patients receive large amount of fluid during the early phase of resuscitation, large amount of acetate are to be administrated if such solutions are used. While acetate-containing solutions have been suggested to be safe in this setting, studies are still lacking regarding clearance and accumulation in critically ill patients.

It is expected to include 28 patients, the objective to analyze the data of 20 patients.

The main objectives of the study is 1) to determine whether Plasmalyte® promote the development of metabolic acidosis in comparison with an acetate-free balanced solutions: Ringer lactate (chloride concentration of 111 mmol/L) and 2) to determine Acetate & gluconate clearance during fluid resuscitation of severely burn patients Plasmalyte® (chloride concentration of 98 mmol/L) . Severely burn patients will be randomized to receive Plasmalyte® or Ringer Lactate for initial fluid resuscitation during the first 5 days following admission.

Inclusion Criteria:

• Patients over 18 years
• TBSA>30%
• Admission to an intensive care unit within 12 hours after burn injury
• Signed informed consent to Patient / Parent / ( Inclusion in Emergency and Consent is Collected)
• social Insurance cover

Exclusion Criteria:

• Decline to participate
• pregnancy
• Metabolic alkalosis (excess of base> 5mmol / L)
• legal obstacle to participate