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Initial fluid management and use of vasopressors in adult severely burned patients: An European survey

Severe burn injury induces early haemodynamic alterations mainly related to rapid loss of intravascular volume due to severe capillary leak and hypovolemic shock. Fluid resuscitation is considered as a corner stone of initial management of burn patients. The ideal amount and type of fluid during initial resuscitation in severely ill burn patients remains largely unknown with a real lack of consensus. The main challenge in the initial fluid administration strategy (first 48 hours) is to maintain the intravascular volume and organ perfusion without inducing both under and over-resuscitation complications. Fluid overload could be at least as harmful as hypoperfusion related to under-resuscitation.

This international survey focuses on the current practices in fluid management and the use of vasopressors for adult severely burned patients (Total body surface area affected by burns > 20%, mechanical ventilation) in the first 48 hours after injury.

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TrainECMO

The optimal management of an anticoagulation target and transfusion practice in VV-ECMO patients is still under debate. Traditionally, the threshold for transfusions of packed red blood cells (PRBC) in ECMO aims to keep haemoglobin values (Hb) in the normal range (12-14 g/dL). More recently, this notion has been challenged by several case series that reported on lower transfusion thresholds and good outcomes. Since blood management practices have evolved over the years, we hypothesise that practices vary widely among ECMO centers.

This survey primarily focuses on the transfusion triggers according to the centre workflow.

Secondly, the questions will focus on the main parameters taken into account in case of uncertainty or if there are other parameters considered to support the decision making process of administering a transfusion.

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