A Review on the Use of Plasma During Acute Burn Resuscitation

2019 ◽  
Vol 41 (2) ◽  
pp. 433-440 ◽  
Author(s):  
Robert Cartotto ◽  
Jeannie Callum
Keyword(s):  
Disease Transmission ◽  
Burn Injury ◽  
Human Albumin ◽  
Fresh Frozen Plasma ◽  
Beneficial Effects ◽  
Volume Expander ◽  
Major Burn ◽  
Fresh Frozen ◽  
Human Albumin Solution ◽  
Burn Resuscitation

Abstract The problem of fluid creep has generated renewed interest in the use of colloids during acute burn resuscitation. Currently, human albumin solution is usually chosen as the resuscitation colloid. However, human plasma was a fundamental component of numerous burn resuscitation formulas historically, but it largely fell out of favor due to concerns surrounding transmission of infectious viruses. Nevertheless, plasma is an effective volume expander which has been demonstrated to reduce overall volume requirements during burn resuscitation. Furthermore, plasma may have beneficial effects on the endothelium by diminishing the microvascular leak that follows a major burn injury. Fresh frozen plasma (FFP) is now much safer from a disease transmission standpoint, and newer forms of solvent-detergent–treated plasma and lyophilized plasma offer potentially even greater safety and efficacy. The use of FFP and newer forms of plasma, which have not been extensively studied, should be investigated as potential adjuncts to acute burn resuscitation.

85 Safety and Efficacy of Early Fresh Frozen Plasma Administration in Burn Resuscitation

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S55-S56 ◽  
Author(s):  
Arek J Wiktor ◽  
Heather Carmichael ◽  
Elizabeth B Weber ◽  
Patrick Duffy ◽  
Anne L Lambert Wagner
Keyword(s):  
Total Body Surface Area ◽  
Fresh Frozen Plasma ◽  
Future Research ◽  
Burn Patients ◽  
Post Injury ◽  
Fresh Frozen ◽  
Total Body ◽  
Abdominal Compartment ◽  
Burn Resuscitation ◽  
Frozen Plasma

Abstract Introduction Controversy exists over the use of colloid required for burn resuscitation. Data show that fresh frozen plasma (FFP) may have benefits beyond volume sparing alone, however, there are inherent risks including transfusion related acute lung injury (TRALI) and transfusion reactions (TR). The aims of this project were: (1) determine the effectiveness of early FFP during burn resuscitation, and (2) to document any potential side effects of FFP administration. Methods A retrospective review was performed on all burn patients aged >18 years old with >20% total body surface area (TBSA) burns who underwent resuscitation using our nursing guided resuscitation protocol (NGRP) from November 2016- June 2019 at our ABA- verified burn center. Excluded were those with electrical injury, delayed resuscitation, polytrauma, renal replacement therapy and or death within 24 hours (hrs) of injury. Pursuant to the NGRP all patients with >30% TBSA burns received FFP at 6–8 hrs post injury. Data recorded included: demographics, % TBSA burned, total crystalloid/FFP, and urine output (UO). An hourly resuscitation ratio (I/O ratio) of fluid given (ml/kg/%TBSA/hr) to UO (ml/kg/hr) was calculated. FFP initiation was standardized to time zero. Major complications such as abdominal compartment syndrome (ACS), acute respiratory distress syndrome (ARDS), TRALI and TR were documented. Univariate statistical analysis was performed. Results Over the study period 71 patients required NGRP resuscitation, 56 met inclusion criteria. Baseline demographics included: 47 male (84%), median age 34 years [IQR 27–53], median TBSA 30% [range 20–95%]. 40 patients were resuscitated with FFP versus 16 patients resuscitated with crystalloid alone. Median time to FFP administration was 7 hours [IQR 6–8] with an average of 1866 ml infused [779–4484]. Those who received FFP had larger % TBSA burns median 41% [29–57] vs no FFP 22% [20–24], p< 0.001. Median I/O ratio at FFP initiation improved from 1.0 [IQR 0.4–3.7] to 0.4 [IQR 0.2–1.5, p=0.01] at 2 hrs post FFP, see Graph. Median UOP improved from 0.18 cc/kg/hr the 2 hrs prior to FFP administration, to 0.44 cc/kg/hr at 2 hrs post FFP (p=0.01). Total 24 hour fluids given (cc/kg/% TBSA) were similar in both groups: FFP 3.94 [3.49–5.36] vs no FFP 3.92 [3.54–4.53], p=0.77. There were no reported incidents of ACS, ARDS, TRALI, or TR. Conclusions The use of FFP in burn resuscitation significantly improves UOP and normalizes I/O ratios. FFP administration did not cause any serious complications. Applicability of Research to Practice Future research efforts should focus on comparing albumin vs FFP in acute burn resuscitation.

scholarly journals Fresh frozen plasma. Useful as a volume expander in children.

BMJ ◽  
1993 ◽  
Vol 307 (6909) ◽  
pp. 935-935 ◽  
Author(s):  
G Stuart ◽  
C Wardrop
Keyword(s):  
Fresh Frozen Plasma ◽  
Volume Expander ◽  
Fresh Frozen ◽  
Frozen Plasma

The need for blood products in patients with crush syndrome

2010 ◽  
Vol 5 (5) ◽  
pp. 295-301 ◽  
Author(s):  
Rumeyza Kazancioglu, MD ◽  
Binnur Pinarbasi, MD ◽  
Bahar Artim Esen, MD ◽  
Aydin Turkmen, MD ◽  
Mehmet S. Sever, MD
Keyword(s):  
Task Force ◽  
Human Albumin ◽  
Fresh Frozen Plasma ◽  
Crush Syndrome ◽  
Blood Products ◽  
Medical Problems ◽  
Multisystem Involvement ◽  
Tertiary Center ◽  
Fresh Frozen ◽  
Mass Disasters

Objectives: Crush syndrome is typical for multisystem involvement because of coexisting major surgical and/or medical problems. Treatment of patients with crush syndrome following mass disasters is even more problematic as hundreds of patients are admitted to hospitals and need therapy at once. In this study, the authors evaluated the need of blood and blood products in patients hospitalized due to crush syndrome after the Marmara earthquake in a single center.Methods: The clinical and laboratory variables regarding 60 patients with crush syndrome (30 males and 30 females; mean age: 31.3 _ 13.8 years) hospitalized at a tertiary center that were documented on the preformed questionnaires distributed by International Society of Nephrology Task Force at the aftermath of the earthquake were analyzed by Statistical Package for Social Sciences for Windows software version 13.0 (SPSS Inc, Chicago, IL, USA).Results: Thirty-nine patients (16 males and 23 females; mean age: 30.1 _ 12.6 years) were transfused with 589 U of blood, 840 U of fresh frozen plasma, and 172 U of human albumin during the hospitalization. Most of the transfusions were performed during the first week after the hospitalization.Conclusions: As a result, the preparation for disasters should also include logistic plans for obtaining sufficient amount of blood and blood products to be used in the early aftermath of the event.

scholarly journals Hypoalbuminemia in critically sick children

2019 ◽  
Vol 6 (3) ◽  
pp. 922
Author(s):  
Sandeep T. Golhar ◽  
Hina Agrawal ◽  
Urmila M. Chauhan ◽  
Abhishek Madhura
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Serum Albumin ◽  
Paediatric Intensive Care Unit ◽  
Human Albumin ◽  
Fresh Frozen Plasma ◽  
Paediatric Intensive Care ◽  
Common Finding ◽  
Fresh Frozen ◽  
Frozen Plasma

Background: Hypoalbuminemia at admission is a common finding in patients admitted to the Paediatric Intensive Care Unit (PICU) and may predict morbidity and mortality.Methods: Patients of age more than 1 year and less than 12 years diagnosed with hypoalbuminemia on the grounds of the inclusion criteria who were admitted in the Paediatric Intensive Care Unit (PICU) were enrolled in the study as ‘cases’ and patients with normal levels of serum albumin and otherwise similar characteristics to cases were included in the study as ‘controls’. Detailed clinical examination and required investigations were done. Above collected information was utilized to select two groups for the study i.e., those with hypoalbuminemia and others with no hypoalbuminemia. Both these groups were further followed up till discharge or death and the outcome in terms of morbidity and mortality was noted.Results: Incidences of MODS and degree of severity of illness as judged by PRISM III score in cases and control showed that, a lower serum albumin concentration correlated well with higher rates of complications such as ventilator dependence and development of new infections leading longer stay in the critical care unit. The mean length of PICU stay in cases group was statistically longer than in the control group. Although we did not observe a difference in fatal outcome in patients managed with either Human Albumin or Fresh Frozen Plasma compared to those managed conservatively in this study, we did observe a decreased mean length of PICU stay and rate of complications in the patients treated with either Human Albumin or Fresh Frozen Plasma, thus achieving a faster rate of recovery with lesser rate of complications and thus alleviating the morbidity, though still not being able to affect the overall mortality.Conclusions: Hypoalbuminemia at admission was a predictive factor of poor outcome in critically ill children. It is associated with a higher mortality, a longer length of stay in the PICU, as well as longer ventilator use.

Intraoperative fresh-frozen plasma versus human albumin in craniofacial surgery − A pilot study comparing coagulation profiles in infants younger than 12 months

2007 ◽  
Vol 98 (07) ◽  
pp. 172-177 ◽  
Author(s):  
Andreas Machotta ◽  
Hanno Riess ◽  
Sabine Kerner ◽  
Olaf Ahlers ◽  
Hannes Haberl ◽  
...  
Keyword(s):  
Pilot Study ◽  
Activation Parameters ◽  
Human Albumin ◽  
Fresh Frozen Plasma ◽  
Craniofacial Surgery ◽  
Volume Replacement ◽  
Postoperative Blood Loss ◽  
Clinical Endpoints ◽  
Fresh Frozen ◽  
Frozen Plasma

SummaryThe transfusion of fresh-frozen plasma (FFP) is suggested to minimize dilution coagulopathy when applied instead of colloids during paediatric craniofacial surgery (pCFS). We prospectively compared plasmatic haemostaseologic function between volume replacement with FFPs versus human albumin (HA) in a pilot study. Thirty infants with primary craniosynostosis were scheduled for pCFS. In 15 of those, FFPs were available from the identical donor as for packed red blood cells (pRBC), and were thus employed for intraoperative volume replacement. The remaining 15 infants were infused with HA-5% instead. Haemoglobin (Hb)-values, global coagulation parameters (activated partial thromboplastin time-aPTT; prothrombin time-PT), selected clotting factors (F) (VIII, XI, XIII), antithrombin-AT, fibrinolytic factors (fibrinogen; plasminogen; alpha2-antiplasmin-α2A), and activation parameters (thrombin-antithrombin-complex-TAT; plasmin-antiplasmin-complex-PAP; D-dimers) were assessed and compared between both groups after induction of anaesthesia, before transfusion of pRBC, and at the end of surgery. Patients and treatment characteristics were balanced between both groups. Prolongation of aPTT and decreases of PT, FXI, FXIII, AT3, and fibrinolytic factors were more pronounced in the HA-group. Increases in F VIII activity, activation parameters, and the course of Hb-values were similar among both groups. There was no difference regarding clinical endpoints (peri-/postoperative pRBC-transfusions, postoperative blood loss). In conclusion, the application of HA was associated with a more distinct dilution of procoagulant factors, AT3, and fibrinolytic factors than the use of FFPs. However, the course of activation markers suggested a similar extent of clotting and fibrinolytic activation with the use of both transfusion regimens, and there were no differences with regard to clinical endpoints.

Binding of vanadate to human albumin in infusion solutions, to proteins in human fresh frozen plasma, and to transferrin

2002 ◽  
Vol 90 (1-2) ◽  
pp. 38-42 ◽  
Author(s):  
Günter Heinemann ◽  
Burckhard Fichtl ◽  
Matthias Mentler ◽  
Wolfgang Vogt
Keyword(s):  
Human Albumin ◽  
Fresh Frozen Plasma ◽  
Fresh Frozen ◽  
Frozen Plasma

A Clinical Pilot Study of Fresh Frozen Plasma versus Human Albumin in Paediatric Craniofacial Repair

2008 ◽  
Vol 36 (1) ◽  
pp. 171-177 ◽  
Author(s):  
T Kerner ◽  
A Machotta ◽  
S Kerner ◽  
O Ahlers ◽  
H Haberl ◽  
...  
Keyword(s):  
Pilot Study ◽  
Human Albumin ◽  
Fresh Frozen Plasma ◽  
Fresh Frozen ◽  
Frozen Plasma

scholarly journals Fresh Frozen Plasma as a Successful Antidotal Supplement in Acute Organophosphate Poisoning

2013 ◽  
Vol 64 (2) ◽  
pp. 273-277 ◽  
Author(s):  
Slavica Vučinić ◽  
Milica Zlatković ◽  
Biljana Antonijević ◽  
Marijana Ćurčić ◽  
Bogdan Bošković
Keyword(s):  
Reference Range ◽  
Fresh Frozen Plasma ◽  
Organophosphate Poisoning ◽  
Pharmacological Treatments ◽  
Beneficial Effects ◽  
Alternative Approach ◽  
Albumin Content ◽  
Fresh Frozen ◽  
Frozen Plasma

Despite improvements to intensive care management and specific pharmacological treatments (atropine, oxime, diazepam), the mortality associated with organophosphate (OP) poisoning has not substantially decreased. The objective of this examination was to describe the role of fresh frozen plasma (FFP) in acute OP poisoning. After a deliberate ingestion of malathion, a 55-year-old male suffering from miosis, somnolence, bradycardia, muscular fasciculations, rales on auscultation, respiratory insufficiency, as well as from an inhibition of red blood cell acetylcholinesterase (AChE) and plasma butyrylcholinesterase (BuChE), was admitted to hospital. Malathion was confirmed in a concentration of 18.01 mg L-1. Apart from supportive measures (including mechanical ventilation for four days), antidotal treatment with atropine, oxime - pralidoxime methylsulphate (ContrathionR), and diazepam was administered, along with FFP. The potentially beneficial effects of FFP therapy included a prompt increase of BuChE activity (from 926 IU L-1 to 3277 IU L-1; reference range from 7000 IU L-1 to 19000 IU L-1) and a reduction in the malathion concentration, followed by clinical recovery. Due to BuChE replacement, albumin content, and volume restitution, FFP treatment may be used as an alternative approach in patients with acute OP poisoning, especially when oximes are not available.

scholarly journals Comparison of the Coagulation Effect Achieved by OctaplasLG Versus Fresh Frozen Plasma in Pediatric Cardiac Surgical Patients

2018 ◽  
Vol 24 (8) ◽  
pp. 1327-1332 ◽  
Author(s):  
Amanpreet S. Kalsi ◽  
Omar Al-Azzawi ◽  
Ravi Gill
Keyword(s):  
Cardiac Surgery ◽  
Disease Transmission ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Laboratory Data ◽  
Coagulation Factor ◽  
Fresh Frozen Plasma ◽  
Clotting Factors ◽  
Fresh Frozen ◽  
Frozen Plasma

OctaplasLG is indicated for use in patients undergoing cardiac surgery who require replacement of multiple clotting factors. The use of OctaplasLG over single-donor fresh frozen plasma (FFP) may have beneficial effects when considering the transmission of enveloped viruses. Additionally, it has the potential for fewer adverse reactions, reduced disease transmission, and a more homogenous coagulation factor composition. However, its efficacy and safety have not yet been evaluated in the pediatric population. Pediatric patients aged less than 2 years old and less than 10 kg, who underwent complete tetralogy of Fallot repair and received either OctaplasLG or FFP intraoperatively were identified over a 10-year period for this retrospective analysis. A review of case notes, intra-operative, and laboratory data were used to assess intraoperative blood product usage, blood loss, and postoperative coagulopathy. Data were analyzed to assess the efficacy of OctaplasLG in achieving hemostasis when compared to FFP. Results showed clinically better hemostasis postoperatively in OctaplasLG group compared with FFP group and better coagulation results. OctaplasLG was as effective as FFP when used in pediatric patients undergoing cardiac surgery.

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