Şok ve Resüsitasyon
Özet
Geniş alan yanıklarında lokal sıvı kaybı ve inflamatuvar mediatörlerin tetiklediği sistemik yanıt nedeniyle dolaşımdaki plazma hacmi kritik düzeyde azalarak travmatik hipovolemik şok tablosu gelişir. Hücresel oksijen arzı ve talebi arasındaki dengesizlikle karakterize olan bu hayatı tehdit edici süreç, hızlı ve etkin şekilde yönetilmediğinde subakut dönemde çoklu organ yetmezliği ve ölümle sonuçlanır. Akut yanık yönetiminin temelini, vasküler geçirgenlik düzelip ödem stabil hale gelene kadar doku perfüzyonunu idame ettirmek amacıyla uygulanan agresif sıvı resüsitasyonu oluşturur. Tedavide aşırı volüm yüklemesinin ("fluid creep") yol açabileceği kardiyak ve pulmoner komplikasyonlardan korunmak için kristalloid olarak çoğunlukla Laktatlı Ringer solüsyonu tercih edilir ve sıvı ihtiyacı Parkland formülü (4 mL/kg/%yanık) ile hesaplanır. Resüsitasyon protokolünün başarısı hastaya sıkı sıkıya bağlı kalmaktan ziyade, foley sonda ile saatlik idrar çıkışının (erişkinlerde 0.5-1 mL/kg/sa) ve arteriyel kan basıncının yakından izlenerek sıvı hızının dinamik bir şekilde titre edilmesiyle sağlanır. Dirençli oligüri vakalarında albümin ve plazma gibi kolloidlerin kullanımı değerlendirilebilir.
In extensive burns, a traumatic hypovolemic shock state develops due to localized fluid loss and systemic responses triggered by inflammatory mediators, which critically deplete circulating plasma volume. Characterized by an imbalance between cellular oxygen supply and demand, this life-threatening process leads to multi-organ failure and death during the subacute phase if not managed rapidly and effectively. The cornerstone of acute burn management involves aggressive fluid resuscitation to maintain tissue perfusion until vascular permeability normalizes and edema stabilizes. To avoid cardiac and pulmonary complications caused by fluid overload ("fluid creep"), Lactated Ringer's solution is preferred as the primary crystalloid, and the fluid requirement is calculated using the Parkland formula (4 mL/kg/%burn). Rather than strictly adhering to formulas, successful resuscitation relies on dynamically titrating fluid rates based on hourly urine output (0.5-1 mL/kg/h in adults) via a Foley catheter and continuous arterial blood pressure monitoring. In cases of refractory oliguria, the administration of colloids such as albumin and plasma may be considered.
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