Fluid resuscitation management in patients with burns: update

Abstract

Since 1968, when Baxter and Shires developed the Parkland formula, little progress has been made in the field of fluid therapy for burn resuscitation, despite advances in haemodynamic monitoring, establishment of the 'goal-directed therapy' concept, and the development of new colloid and crystalloid solutions. Burn patients receive a larger amount of fluids in the first hours than any other trauma patients. Initial resuscitation is based on crystalloids because of the increased capillary permeability occurring during the first 24 h. After that time, some colloids, but not all, are accepted. Since the emergence of the Pharmacovigilance Risk Assessment Committee alert from the European Medicines Agency concerning hydroxyethyl starches, solutions containing this component are not recommended for burns. But the question is: what do we really know about fluid resuscitation in burns? To provide an answer, we carried out a non-systematic review to clarify how to quantify the amount of fluids needed, what the current evidence says about the available solutions, and which solution is the most appropriate for burn patients based on the available knowledge.

Plasma for burn shock resuscitation: is it time to go back to the future?

“…29 Possibly, changes in the medical fitness of the population, with an increased incidence of diabetes and substance addiction, may also affect fluid needs. 30 In a thorough evaluation of the literature, Guilabert et al 77 performed a nonsystematic review to help determine the current evidence and recommendations for the early resuscitation of burn patients. In their review, published in the British Journal of Anaesthesiology in September 2016, they observed that many burn units based their resuscitation practices on formulas that were almost 50 years old despite the advances in hemodynamic monitoring.…”

Resuscitation using less fluid has no negative impact on hydration status in children with moderate sized scalds: a prospective single-centre UK study

“…The majority of burn services in England and Wales use resuscitation volumes based on the Parkland Formula of between 3 and 4mL/kg/%BSA [18]. There is still a considerable variation in fluid resuscitation protocols between services, representing a lack of consensus in how moderate sized partial thickness scalds in children should be resuscitated and very little high quality evidence is available to guide practice [24,25]. Most of the literature reporting problems with using a large volume of fluid arise from research on adult burns, but evidence is emerging that the same may be true in children.…”

Fluid Therapy and Management

“…Hipertonik solüsyonlar, albumin ve plazma, başlangıç resüsitasyon volüm gereksinimini azaltmakta, batın içi basıncın (İAB) artmamasına ve kompartman sendromu sıklığının azalmasına yol aç-maktadır. Yanık olgularında yeğlenecek solüsyonlar-dır [33] .…”