Burn fluid resuscitation using plasmalyte®: Is it a safe replacement for ringers lactate and what is the potential cost saving?
Published Date: 04th May 2022
Publication Authors: Cappuyns L, Tridente A, Stubbington Y, Shokrollahi K
Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf
Introduction
Fluid resuscitation remains the basis of early burn management. Both the type and volume of fluids can impact the outcome of burn patients. Appropriate fluid resuscitation is at the core of hemodynamic management and has long been identified as a key factor for patients with major burns. Ringer’s lactate (RL) has been the most widely used fluid for burn resuscitation for decades . Plasmalyte®, a newer balanced crystalloid, is gaining popularity for use in critically ill patients including those with burns. This popularity is partly due to the fact that Plasmalyte® theoretically offers a favourable metabolic profile, but may also be attributed to its relatively lower cost. Patients with large burns receive very large volumes of fluids, especially during the resuscitation period and these high volumes may have metabolic consequences.
Aim
Following a trust-wide formulary change from RL to Plasmalyte®, we decided to explore existing evidence and rationale supporting the use of Plasmalyte® as an alternative to the standard RL solution for resuscitation in burns.
Methods
We comprehensively searched Medline, Embase, Google scholar and the Cochrane library for articles on the use of Plasmalyte® Vs RL for burn resuscitation in adults.
Conclusions
Based on the limited literature on the use of Plasmaltye® in burns, it is difficult to draw firm conclusions. However, the evidence that currently exists does not suggest that Plasmalyte® is unsafe for burn resuscitation. Furthermore there are potential cost savings of the order of 42%. We advise against formulary changes that remove access to RL. RL should continue to be available for use in burn patients until such time that research has established the safety profile of large volume resuscitation with Plasmalyte® more conclusively.
Cappuyns, L; Tridente, A; Stubbington, Y; Dempsey, NC; Shokrollahi, K. (2022). Burn fluid resuscitation using plasmalyte®: Is it a safe replacement for ringers lactate and what is the potential cost saving? Conference poster from British Burns Association Annual Meeting, 4th-6th May 2022.
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