The Combination of Parkland Formula, Using Normal Saline, with Muir & Barclay Formula for Fluid Resuscitation in the Initial Burn Shock Period

Abstract

Objectives: Evaluation of the effects of withholding plasma during the initial part of the burn shock period (the shock period in the study is estimated as the first 36 hours following the burns) when it will be lost into the interstitial tissues through the permeable capillaries. During that time crystalloids are administered. Another objective is to evaluate the effect of administering normal saline as the crystalloid resuscitation fluid during the initial part of the shock period. Design: A Retrospective 4 years study compares the use of normal saline as the resuscitative intravenous fluid during the first 12 hours post burns followed by intravenous 5% Purified Plasma Protein Fraction (PPPF) during the rest of the shock period i.e. the remaining 24 hours, with the use of the PPPF throughout the burns shock period according to Muir and Barclay formula. Setting: The Plastic Surgery Department and the Department of Laboratory, Directorate General of Khoula Tertiary Hospital, Muscat, Sultanate of Oman. Patients and Methods: The study included 2 groups of patients; Group A: Patients who received 5% Plasma (Human PPPF) throughout the shock period and Group B: Patients who received crystalloids in the form of normal saline during the first 12 hours post burn followed by plasma for the next 24 hours. Monitoring of the patients in both groups was done by using clinical signs of pulse, blood pressure, temperature and urine output and by using laboratory investigations in the form of the haematocrit value, sodium, potassium, chloride, total proteins and albumin levels in the blood at the time of admission and at the end of the shock period. Results: 140 patients were included in the study; 64 in Group A and 76 in Group B. There was no mortality and the vital signs were maintained during the shock period in both groups. The mean values of urine output were nearer to the normal level in Group B compared to Group A. The same was observed regarding the Haematocrit value. In both groups the mean values showed no hypoproteinaemia or hypoalbuminaemia at the end of the shock period. There was no hypernatraemia in spite of giving 150 mmol/L of Na during the initial 12 hours post burns in Group B. The mean values of potassium and chloride levels were normal in both groups at the end of the shock period. Conclusion: Giving plasma during the first 12 hours of the burn shock period when the capillary leakage is maximum has no significant benefit. The plasma usage can be reduced by 50% compared to the use of the Muir and Barclay Formula from the beginning of the shock period with reduction of the costs and the possibility of transmission of undetected pathogens by nearly the same value if crystalloids are given during the first 12 hours of burns shock period. The use of isotonic normal saline during the first 12 hours appears more appropriate as it maintains adequate sodium balance to correct the hyponatraemia and at the same time prevents elevation of the serum potassium during the period when potassium is released from the cells. In addition, it does not have a significant reduction on the level of the serum proteins.