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.

Does Ringer Lactate Used in Parkland Formula for Burn Resuscitation Adequately Restore Body Electrolytes and Proteins?

“…However, survival in our cohort was 100% and this may indicate that mortality during the initial period of resuscitation may not be a sensitive outcome for the importance of colloids and specifically, albumin. This comes as a confirmation of our previous findings of 0% mortality in our previous similar cohorts and further downgrades this outcome as a legitimate marker of the usefulness of colloids [26]. Additionally, from our experience, deaths that may occur at a later stage may be due to complications such as septic shock and hence albumin may need to be reconsidered for these patients in burn shock phase.…”

“…This is an important limitation in our study which other groups has to overcome by performing controlled investigations. However, if we take our previous study [26] as a historical control, we find that with a relatively small sam- Nevertheless, we suggest that other centers attempt at replicating our findings and possibly include a reference arm.…”

“…Therefore, it would be important to see if these effects would be achieved by modifying the current recommended solutions such that they contain more sodium. In fact, we have previously shown [26] in a retrospective study that when normal saline (154 mEq/L) was used together with proteins (colloids) as a resuscitative fluid, patients were more likely to have normal sodium blood levels. Cohort in that analysis included 76 patients who received normal saline during the 1st 12 hours of the shock period followed by 5% purified plasma protein fraction for the rest of the shock period.…”