Advances in fluid therapy and the early care of the burn patient

Abstract

The resuscitation and early care of the burn patient has been placed on a more sound physiologic basis as a result of recent studies of the pathologic effects of thermal injury and the clinical application of technological advances. Whichever resuscitation formula is employed, its application should be guided by the patient's response to treatment. The surgeon must preserve vital organ function while taking advantage of compensatory mechanisms to minimize the deleterious effects of both the injury and the therapy. Resuscitation using only balanced salt solution in the first 24 hours, and reserving colloid-containing fluids for the second 24 hours, is clinically effective in the vast majority of burn patients, but should be altered in terms of volume and composition to meet the particular needs of any given burn patient. Repeated planned monitoring of cardiopulmonary function and of the peripheral circulation is mandatory to achieve maximum survival of unburned tissue and to reduce mortality. Careful fluid management, including daily assessment of fluid balance, is required from the time of admission until the burn wound has healed or been grafted.Methods of resuscitation of the extensively burned patient have changed strikingly during the past half century with a resultant marked reduction of morbidity and mortality due to burn shock, hypovolemia, and acute renal failure. The importance of salt-containing fluids in restoring blood volume deficits in the early postburn period was first recognized by Parascondolo

Predicting Increased Fluid Requirements During the Resuscitation of Thermally Injured Patients

“…In one review, 2.88 mL/kg/% burn was the final dose administered under the modified Brooke formula. 16 In a recent multicenter review of experience with 50 patients, 5.2 mL/ kg/% burn was the final dose given under the Parkland formula. 17 Clearly, however, the relative merits of the various resuscitation formulas could only be determined on the basis of prospective, randomized trials.…”

The changing epidemiology of infection in burn patients

“…Infection has always been the predominant determinant of WOUnd healing, incidence of complications, and outcome of burn patients. The marked decrease in shock and acute renal failure as causes of death that has resulted from the use of effective fluid resuscitation regimens in patients with extensive burns has only served to increase the relative importance of infection in that subset of burn patients [1]. Other improvements in care that protect organ function and prevent complications, such as exsanguinating hemorrhage from stress ulcers, have further accentuated infection as the most frequent cause of burn patient morbidity and mortality [2].…”

Reciprocal Learning Between Military and Civilian Surgeons

“…48 Pruitt and his colleagues subsequently established a scientific program whose investigations prompted groundbreaking insights into the physiological and metabolic dysregulation in burn trauma victims, changing the surgical practice in both the military and civilian sectors. 49…”