INVASIVE CENTRAL HEMODYNAMICS MONITORING IN ACUTE PERIOD OF SEVERE BURN TRAUMA AS A METHOD OF INTENSIVE CARE OPTIMIZATION
Objective - to determine the hemodynamic profile of severe burn shock (BS), and estimate abilities of PiCCO-monitoring for infusion therapy volume optimization and choice of vaso- and inotropic agent in treatment of BS. Materials and methods. Effectiveness of invasive PiCCO-monitoring of central hemodynamic was investigated in 78 patients in acute period of severe burn trauma (degrees of severity 2-3, > 40 % of body surface). Results. Application of PiCCO-monitoring made it possible to decrease infusion volume by 2-2.5 L in the first day (or up to 3-3.5 ml × % of burnt surface × body weight). Moreover, the deep analysis of PiCCO-monitoring in acute period of burn injury showed the dobutamine as the most effective agent for burn shock due to both venotonic and inotropic actions with increasing preload without increase of infusion volume. Conclusion. PiCCO-monitoring is recommended for realization of restrictive strategy of infusion therapy for patients with severe burns, as well as for the optimal choice of medications and dosages of inotropic/ vasopressor support. In addition, assessment of pulmonary free fluid and of pulmonary artery pressure presents the most valuable predictors of acute lung injury.