Abstract
BackgroundBurn fluid resuscitation guidelines have not specifically addressed mass casualty with resource limited situations, except for oral rehydration for burns below 40% total body surface area (TBSA). The World Health Organization Technical Working Group on Burns (TWGB) recommends an initial fluid rate of 100 mL/kg/24 h, either orally or intravenously, beyond 20% TBSA burned. We aimed to compare this formula with current guidelines. MethodsThe TWGB formula was numerically compared with 2–4 mL/kg/%TBSA for adults and the Galveston formula for children. ResultsIn adults, the TWGB formula estimated fluid volumes within the range of current guidelines for burns between 25 and 50% TBSA, and a maximal 20 mL/kg/24 h difference in the 20–25% and the 50–60% TBSA ranges. In children, estimated resuscitation volumes between 20 and 60% TBSA approximated estimations by the Galveston formula, but only partially compensated for maintenance fluids. Beyond 60% TBSA, the TWGB formula underestimated fluid to be given in all age groups. ConclusionThe TWGB formula for mass burn casualties may enable appropriate fluid resuscitation for most salvageable burned patients in disasters. This simple formula is easy to implement. It should simplify patient management including transfers, reduce the risk of early complications, and thereby optimize disaster response, provided that tailored resuscitation is given whenever specialized care becomes available.
Highlights
Burn fluid resuscitation guidelines have not addressed mass casualty with resource limited situations, except for oral rehydration for burns below 40% total body surface area (TBSA)
Comparison of resuscitation fluid estimates between the Technical Working Group on Burns (TWGB) fluid resuscitation formula for mass burn casualties [17] and the existing guidelines consensus formula of 2 to 4 mL/kg/ %TBSA [4À6] were in agreement in the 25À50 %TBSA range, where TWGB estimated fluid to be given fell within the range of the consensus formula (Fig. 1)
For children between 5 and 45 kg, a tridimensional comparison view of resuscitation fluid estimates for the first 24 h depending on %TBSA burned and body weight is shown in Fig. 2, as calculated by the TWGB fluid resuscitation formula for mass burn casualties [17] and by the Galveston formula [18]
Summary
Burn fluid resuscitation guidelines have not addressed mass casualty with resource limited situations, except for oral rehydration for burns below 40% total body surface area (TBSA). Many different formulae have been proposed to estimate fluids to be given in severely burned patients, the original Parkland [1] and Evans [2] / Brooke [3] formulae still prevail in current consensus guidelines of 2 to 4 mL/kg body weight/% total body surface area burned (%TBSA) [4À6], respectively as their upper and lower range. The aforementioned resuscitation formulae were all based on retrospective analysis of favorable outcomes and none have been validated in larger randomized controlled trials [6,8] These resuscitation formulae were not promoted as rigorous treatment plans, but rather as starting points from which clinical judgment and hemodynamic monitoring render adjustments [5,6]. This has led to recommendations on fluid resuscitation per os using Oral Rehydration Solution (ORS) up to 40% TBSA, but not to new recommendations on fluid resuscitation formulae [15]
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