A Randomized Trial of Plasma Exchange in the Treatment of Burn Shock

Hypovolemia following major thermal injury results from increased capillary permeability with subsequent loss of fluid into the interstitium. Investigations of burn shock have demonstrated the release of circulating factors that effect these fluid shifts. Previous studies have suggested that this process can be altered by the performance of plasma exchange in patients who fail to respond to conventional resuscitation. This study evaluated the effect of plasma exchange during burn shock. Twenty-two adult subjects were randomly assigned to one of two groups. The control group received standard fluid resuscitation guided by the Parkland formula; the treatment group received the same resuscitation in addition to a course of plasma exchange. Seventeen subjects, eight from the control group and nine from the plasma exchange group, completed the study. Control subjects had a mean age of 37 years, a mean burn size of 52.3% total body surface area, and a mean full-thickness injury of 24.6% total body surface area. Plasma exchange patients had a mean age of 38 years, a mean burn size of 49.4% total body surface area, and a mean full-thickness injury of 37.3% total body surface area (p less than 0.01 compared to the control group). Completion of resuscitation was accomplished earlier in the plasma exchange group (20.2 hours versus 30.8 hours; p less than 0.05). There was no difference in the total amount of fluid required to achieve resuscitation. The mean urine output during resuscitation was greater for the plasma exchange group (p less than 0.01). Performance of plasma exchange during the second 8-hour period after the burn did not alter the course of burn shock in this study group.