The treatment of burn shock: results of a 5-year randomized,controlled clinical trial of Dextran 70 v. Ringer lactate solution

Whether colloid mixtures or exclusively electrolyte solutions should be preferred for treatment of burn shock has been a topic of discussion for many years. The burns unit in Copenhagen has run a randomized, controlled trial, during the 5-year period 1971-5, in which every even-numbered patient was treated with Dextran 70 and every odd-numbered patient with Ringer lactate. Each group comprised 86 patients. The manner in which the two patient groups respond to treatment is essentially different. The characteristic features of the Dextran group are the relatively small quantities of fluid and sodium administered, the moderate hourly diuresis, the lack of haemoconcentration and reduced sodium uresis during the days subsequent to institution of shock treatment. Patients treated with Ringer lactate, on the contrary, receive more fluid and sodium, the hourly diuresis will be larger, but in spite of this these patients tend to haemoconcentrate to a considerable degree. The sodium uresis is normal all the time. Thus, these two methods of treatment create entirely different pathophysiological conditions. The weight of the patients treated with Ringer lactate is significantly greater than that of those treated with Dextran 70, but there is no difference in the extent of the burn either in square metres or in the percentage of body surface burned. A comparison is therefore permissible. The 86 patients treated with Dextran 70 had a calculated mortality of 29·9 according to Bull and Fisher (1954) and an actual mortality of 18. The 86 patients treated with Ringer lactate had an expected mortality of 32·5 and an actual mortality of 16. No statistically significant difference in mortality is to be found between the two groups. The authors consequently conclude that Ringer lactate is to be preferred to Dextran 70 because it is simpler to dose; dosing instructions do not lead to misinterpretation, treatment rarely needs to be adjusted and it is practically impossible to give an overdose.