Abstract
Fluid resuscitation following burn injury must support organ perfusion with the least amount of fluid necessary and the least physiological cost. Under resuscitation may lead to organ failure and death. With adoption of weight and injury size-based formulas for resuscitation, multiple organ dysfunction and inadequate resuscitation have become uncommon. Instead, administration of fluid volumes well in excess of historic guidelines has been reported. A number of strategies including greater use of colloids and vasoactive drugs are now under investigation to optimize preservation of end organ function while avoiding complications which can include respiratory failure and compartment syndromes. Adjuncts to resuscitation, such as antioxidants, are also being investigated along with parameters beyond urine output and vital signs to identify endpoints of therapy. Here we briefly review the state-of-the-art and provide a sample of protocols now under investigation in North American burn centers.
Highlights
One of the most challenging aspects of caring for burned patients is the acute resuscitation
Their formula of 3.5 to 4.5 ml of lactated Ringers per %TBSA per kilogram became known as the Parkland formula after the Dallas medical complex in which their experiments took place [2]
Lawrence et al performed a retrospective review of 52 burn patients with greater than 20% TBSA burns
Summary
One of the most challenging aspects of caring for burned patients is the acute resuscitation. The same group examined 53 pediatric patients with greater than 15% TBSA burns and found that patients with higher than predicted fluid volumes “normalized” with albumin administration. Klein et al reviewed the use of plasma exchange at their institution over a 5year period, in which 37 burn patients underwent plasma exchange during their acute resuscitation, seven of whom received two treatments for a total of 44 plasma exchanges These were severe burns with a mean %TBSA of 48.6%, and 73% of the patients had associated inhalation injury. Plasma exchange was triggered by fluid volumes of 1.2 times that predicted by the Parkland formula, or by continued low urine output or hypotension in the face of escalating fluid rates. The authors caution that treatment should not be withheld based on any individual laboratory value [30]
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