|Early and increased amounts of plasma have been associated with improved survival after penetrating and blunt injury. However, no studies involving burn patients demonstrate the effects of intraoperative plasma administration on postoperative resuscitation requirements.
This study examined perioperative transfusion ratios [plasma:RBC (P:R)] and the role of early, aggressive plasma administration in a contemporary burn center. Avoiding the transfusion of plasma until a full volume of red cells has been replaced is not the only recommendation that has been challenged. There are multiple papers from both military and civilian medical centers that deem the 1:3 plasma to RBC transfusion ratio inadequate. One retrospective study of patients in a combat support hospital found that a transfusion ratio of plasma to RBCs of around 1:1 led to an increased rate of survival. While burn patients may not have initial hemorrhage (though many of our military patients do have other injuries that cause immediate hemorrhage), all patients who require large scale excision and skin grafting may become candidates for blood transfusions. Considering that our average estimated blood loss for this study was nearly 1.5 L, it is not surprising that nearly all of our massively burned patients eventually require transfusion.
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