Fluid management in major burn injuries

Abstract

It is a widely accepted fact that severe fluid loss is the greatest problem faced following major burn injuries. Therefore, effective fluid resuscitation is one of the cornerstones of modern burn treatment. The aim of this article is to review the current approaches available for modern trends in fluid management for major burn patients. As these current approaches are based on various experiences all over the world, the knowledge is essential to improve the status of this patient group.

Management of Burn Injuries in the Wilderness: Lessons from Low-Resource Settings

“…[29][30][31] It calls for 4 mL/kg/% TBSA of Ringer's lactate solution over the first 24 hours; half of the fluid is given within the first 8 hours after injury and the other half is given over the next 16 hours. Concern that excess fluid administration contributes to burn edema and lung injury have led to multiple modifications of resuscitation protocols. 32 The Modified Brooke formula calls for 2 mg/kg/%TBSA in adults and 3 mg/kg/%TBSA in children in the first 24 hours. The United States Armed Forces Institute of Surgical Research has recently proposed a simplified formula, the "rule of 10" in which patients are administered 10 mL Ringer's lactate solution for every %TBSA per hour, with hourly adjustments based on clinical response and urine output.…”

Síndrome Compartimental Agudo en El Paciente Quemado Eléctrico

“…Las quemaduras por electricidad pueden ser por contacto o por rayería (6)(7)(8) y constituyen un 3-4% de todas las quemaduras por año en E.E.U.U. (7) .…”

“…Las quemaduras circunferenciales de espesor total, pueden causar un SCA secundario a constricción del tejido por pérdida de elasticidad, y a la presencia de escara y edema. La reposición enérgica de fluidos contribuye a la patología por aumento del edema en las extremidades (3)(4)(5)(6)(7)(8)(9)(10)(11)(12) .…”

“…Cuando la presión compartimental excede los 30 mmHg, el drenaje linfático colapsa. El drenaje venoso y linfático inadecuado generan edema tisular y aumento de la presión intersticial (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) .…”

“…Se define como síndrome compartimental agudo (SCA) cuando se da una elevación aguda de la presión intracompartimental por alguna injuria, por otro lado, el síndrome compartimental crónico o por esfuerzo, no suele ser una emergencia y se presenta mayormente en atletas (5)(6) .…”