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Critical Care

Open Access

Evaluation of a protocol for resuscitation in burn patients

  • Manuel Sánchez-Sánchez1Email author,
  • Abelardo Garcia-de-Lorenzo1,
  • Eva Herrero1,
  • Beatriz Galván1,
  • Maria J Asensio1 and
  • Lucia Cachafeiro1
Critical Care201418:430

Published: 20 May 2014


Parenteral NutritionEnteral NutritionSequential Organ Failure AssessmentTotal Parenteral NutritionKlebsiella Pneumoniae

We have read the commentary by Berger and Que [1] about our paper [2]. We are thankful to them for their comments; we would like to clarify some points.

First, the crude mortality rate, duration of mechanical ventilation, and renal dysfunction cannot be solely attributed to the resuscitation protocol. In addition, other factors are involved, such as intercurrent infection caused by an outbreak of multidrug-resistant Klebsiella pneumoniae strain [3].

Second, the relative initial elevation of the Sequential Organ Failure Assessment score or some intra-abdominal pressure measurements >20 mmHg cannot be interpreted as a failure due to resuscitation.

Third, clinical practices involving surgery, hydrotherapy under sedation, and other traumatic situations often prevent an adequate supply of nutrients with enteral nutrition; this problem is also applicable to those patients whose enteral nutrition is started early. Consequently, parenteral nutrition as a supplement to enteral nutrition is often recommended in such cases [4], which is actually not total parenteral nutrition, and the use of supplementary parenteral nutrition does not reflect gut dysfunction.

Finally, the use of a resuscitation protocol for monitoring transpulmonary thermodilution parameters at below-normal levels and ensuring tissue perfusion with lactate measurements was safe and avoided over-resuscitation, and was also necessary because hypovolemia might not be reflected by urine output. Future studies may reveal appropriate targets to achieve better results with this monitoring.


Authors’ Affiliations

Unidad de Quemados Críticos, Servicio de Medicina Intensiva, Hospital Universitario La Paz/Idipaz, Madrid, Spain


  1. Berger M, Que Y: A protocol guided by transpulmonary thermodilution and lactate levels for resuscitation of patients with severe burns. Crit Care 2013, 17: 195. 10.1186/cc13101PubMedPubMed CentralView ArticleGoogle Scholar
  2. Sánchez-Sánchez M, Garcia-de-Lorenzo A, Herrero E, Lopez T, Galván B, Asensio M, Cachafeiro L, Casado C: A protocol for resuscitation of severe burn patients guided by transpulmonary thermodilution and lactate levels: a 3-year prospective cohort study. Crit Care 2013, 17: R176. 10.1186/cc12855View ArticleGoogle Scholar
  3. Sánchez M, Herruzo R, Marban A, Araujo P, Asensio M, Leyva F: Risk factors for outbreaks of multidrug-resistant Klebsiella pneumoniae in critical burn patients. J Burn Care Res 2012, 33: 386-392. 10.1097/BCR.0b013e318231df95PubMedView ArticleGoogle Scholar
  4. Garcia-de-Lorenzo A, Grau T, Montejo J, Ortiz-Leyva C, Ruiz S: Complementary parenteral nutrition in the critically ill patient. Nutr Hosp 2008, 23: 203-205.Google Scholar


© Sánchez-Sánchez et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.