Standard variables fail to identify patients who will not respond to fluid resuscitation following thermal injury: brief report

Cancio, Leopoldo C.; Reifenberg, Lilane; Barillo, David J.; Moreau, Aimee R; Chávez, Saturnino; Bird, Patti; Goodwin, Cleon W.

doi:10.1016/j.burns.2004.11.009

Cited by 21 publications

(8 citation statements)

References 25 publications

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“…10 Cancio et al found that while "resuscitation failure" correlated with burn size, it could not be predicted on patient characteristics alone. 60 Other factors-including, perhaps, the volume of initial fluid therapy-appeared to play a role. This mechanism could explain why the fluid requirements documented in some recent reports are continuing to escalate to volumes far in excess of Parkland calculations, seemingly without limit.…”

Section: Influence Of Excessive Crystalloid Infusion On Starling Forcesmentioning

confidence: 97%

“…In a recent review of burn resuscitation, Cancio et al found that fluid requirements correlated with both total and full-thickness burn size, ranging from approximately 4.0 ml/kg/%TBSA for moderate injuries to almost 6.0 ml/kg/%TBSA for burns of 80% to 100% TBSA, 59 and that patients with the largest injuries were most likely to fail resuscitation attempts. 60 Today mortality from burn injuries is at an all-time low. Many patients with massive injuries survive, often following aggressive resuscitation well beyond Parkland confines.…”

Section: The Parkland Formula Isn't Accurate Especially For Very Larmentioning

confidence: 99%

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The Phenomenon of “Fluid Creep” in Acute Burn Resuscitation

Saffle

2007

Journal of Burn Care & Research

287

146

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Several reports have documented that modern burn patients receive far more resuscitation fluid than predicted by the Parkland formula-a phenomenon termed "fluid creep." This article reviews the incidence, consequences, and possible etiologies of fluid creep in modern practice and uses this information to propose some therapeutic strategies to reduce or eliminate excessive fluid resuscitation in burn care. A literature review was performed of historical references that form the foundation of modern fluid resuscitation, as well as reports of fluid creep and its consequences. The original Parkland formula required a 24-hour volume of 4 ml/kg/%TBSA lactated Ringer's solution followed by an infusion of 0.3-0.5 ml/kg/ %TBSA plasma. Modern iterations of this formula have omitted the colloid bolus. Numerous exceptions to the formula have been noted, most consistently patients with inhalation injuries. In contrast, recent reports document greatly increased fluid requirements in unselected patients, which seems to consist largely of progressive edema formation in unburned areas, increasing after the first 8 hours post-burn. This has been linked to occurrence of the abdominal compartment syndrome and other serious complications. Strategies to reduce fluid creep include the avoidance of early overresuscitation, use of colloid as a routine component of resuscitation or for "rescue," and adherence to protocols for fluid resuscitation. Fluid creep is a significant problem in modern burn care. Review of original investigations of burn shock, coupled with modern reports of fluid creep, suggests several mechanisms by which this problem can be controlled. Prospective trials of these therapies are needed to confirm their effectiveness.

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Section: Influence Of Excessive Crystalloid Infusion On Starling Forcesmentioning

confidence: 97%

Section: The Parkland Formula Isn't Accurate Especially For Very Larmentioning

confidence: 99%

The Phenomenon of “Fluid Creep” in Acute Burn Resuscitation

Saffle

2007

Journal of Burn Care & Research

287

146

View full text Add to dashboard Cite

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“…It is not possible to accurately predict who will fail resuscitation, but patients who routinely require additional fluid include those with inhalation injury, electrical burns, those in whom resuscitation is delayed, and those using alcohol or illicit drugs (42). Patients making methamphetamine have larger, deeper burns (43) and often require two to three times the standard Consensus formula resuscitation (43,44).…”

Section: Resuscitation Formulasmentioning

confidence: 99%

Critical care of the burn patient: The first 48 hours

Latenser

2009

Critical Care Medicine

185

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The critically burned patient differs from other critically ill patients in many ways, the most important being the necessity of a team approach to patient care. The burn patient is best cared for in a dedicated burn center where resuscitation and monitoring concentrate on the pathophysiology of burns, inhalation injury, and edema formation. Early operative intervention and wound closure, metabolic interventions, early enteral nutrition, and intensive glucose control have led to continued improvements in outcome. Prevention of complications such as hypothermia and compartment syndromes is part of burn critical care. The myriad areas where standards and guidelines are currently determined only by expert opinion will become driven by level 1 data only by continued research into the critical care of the burn patient.

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“…Lack of experience and inadequate attention to detail may play a role. Clinicians appear more apt to increase the fluid infusion rate during periods of oliguria than they are to decrease it during periods of excessive urine output . Sullivan and coauthors noted an increase in the use of opioid analgesics between the late 1970s and the early 2000s, which they termed opioid creep .…”

Section: The Conundrum: Underresuscitation and Shock Versus “Fluid Crmentioning

confidence: 99%

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

2019

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Patients with burn shock can be challenging to resuscitate. Burn shock produces a variety of physiologic derangements: Patients are hypovolemic from volume loss, have a increased systemic vascular resistance, and may have a depressed cardiac output depending on the extent of the thermal injury. Additionally, the burn wound produces a significant inflammatory cascade of events that contributes to the shock state. Fluid resuscitation is foundational for the initial treatment of burn shock. Typical resuscitation is with intravenous lactated Ringer's in accordance with well‐established formulas based on burn wound size. In the past century, as therapies to treat thermal injuries were being developed, plasma was the fluid used for burn resuscitation; in fact, plasma was used in World War II and throughout the 1950s and 1960s. Plasma was abandoned because of infectious risks and complications. Despite huge strides in transfusion medicine and the increased safety of blood products, plasma has never been readopted for burn resuscitation. Over the past 15 years, there has been a paradigm shift in trauma resuscitation: Less crystalloid and more blood products are used; this strategy has demonstrated improved outcomes. Plasma is a physiologic fluid that stabilizes the endothelium. The endotheliopathy of trauma has been described and is mitigated by transfusion strategies with a 1:1 ratio of RBCs to plasma. Thermal injury also results in endothelial dysfunction: the endotheliopathy of burns. Plasma is likely a better resuscitation fluid for patients with significant burn wounds because of its capability to restore intravascular volume status and treat the endotheliopathy of burns.

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Standard variables fail to identify patients who will not respond to fluid resuscitation following thermal injury: brief report

Cited by 21 publications

References 25 publications

The Phenomenon of “Fluid Creep” in Acute Burn Resuscitation

The Phenomenon of “Fluid Creep” in Acute Burn Resuscitation

Critical care of the burn patient: The first 48 hours

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

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