Đánh giá hiệu quả điều chỉnh huyết động theo mục tiêu ở người bệnh bỏng nặng dưới hướng dẫn của Uscom trong 72 giờ đầu sau bỏng

Abstract

Objective: To evaluate the effectiveness of target-based hemodynamic adjustment under USCOM guidance in severe burn patients within the first 72 hours after burns.
Subject and Methods: A cross-sectional descriptive study was conducted on 30 severe burn patients who were treated in the Intensive Care Unit of the National Burn Hospital within 8 hours after burns, from August 2023 to May 2024. Patients were monitored and resuscitated under USCOM guidance, monitoring changes in hemodynamic parameters measured by USCOM, evaluating the effectiveness of resuscitation according to USCOM through pulse rate, mean blood pressure (BP) and central venous pressure (CVP) according to the target at 8 hours (T1), 24 hours (T2), 48 hours (T3) and 72 hours (T4) post-burn.
Results: Hemodynamic parameters assessing general circulation and preload (CO/CI, SV/SVI, FTc) all decreased immediately post-burn and returned to normal ranges after resuscitation. CVP was closely correlated with preload assessment parameters (rSVI = 0,5268, rSVV = -0,6867, rFTc = 0,7804). The patient's heart rate was higher than 90 beats per minute but not exceeding 120 beats per minute. MAP remained consistently above 65 mmHg from admission to 72 hours. CVP dropped below the normal value (< 8 mmHg) during 48 hours after the burn and which returned to the normal value (≥ 8 mmHg) after 48 hours.
At times T3 and T4, 100% of patients reached the target MAP ≥ 65 mmHg. At times T3, 50% of patients achieved the target CVP ≥ 8 mmHg, reaching 100% at T4.
Conclusion: After 72 hours of target-based fluid resuscitation under USCOM guidance, 100% of patients achieved treatment goals for heart rate, MAP, and CVP.