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The role of invasive monitoring in the resuscitation of major burns: a systematic review and meta-analysis.

Increasingly, in major hospitals invasive monitoring endpoints are utilised to guide the acute resuscitation of burns. The aim of this review is to evaluate effects of invasive monitoring for major burns patients (>20% total body surface area) to prevent early organ dysfunction. Five databases were searched for randomised controlled trials and cohort studies that evaluated invasive monitoring within the acute phase (first 24 hours). Invasive monitoring included transesophageal echocardiogram, central venous pressure measurement, and pulmonary artery catheterisation. Primary outcomes included multiple organ failure scores, renal and cardiac dysfunction measurements, compartment syndrome and lactate at 24 hours. Secondary outcomes included mortality and intensive care unit stay. Ten studies involving 401 major burns patients were included. Data pooled from four studies demonstrated significantly improved cardiac index at 24 hours compared to non-invasive endpoints (MD: 0.65, 95% CI: 0.46-0.82, P=0.00001). Five studies pooled showed significantly increased urine output with invasive monitoring (MD: 0.18, 95% CI: 0.03-0.34, P=0.02), whereas there was no difference in blood lactate levels (MD: -0.11, 95% CI: -0.44-0.22, P=0.43). There was a trend for lower mortality in invasive monitoring groups compared with non-invasive controls; however, the difference was not significant. There remains insufficient evidence to determine whether invasive monitoring to guide fluid resuscitation improves patient outcomes after major burn trauma. Although meta-analysis determined significantly improved cardiac index and urine output, further studies are required.