What is used to determine resuscitation therapy in a burn patient?

From the Guidelines

To determine resuscitation therapy in a burn patient, use the Parkland formula (4 mL × patient's weight in kg × percentage of total body surface area burned) to calculate the fluid requirements for the first 24 hours post-burn, as it serves as a starting point for fluid replacement due to increased capillary permeability and fluid shifts caused by burn injuries 1.

Key Considerations

• The Parkland formula is used to estimate the fluid requirements for the first 24 hours post-burn, with half of the calculated volume administered in the first 8 hours and the remaining half given over the next 16 hours.
• Lactated Ringer's solution is the preferred fluid for initial resuscitation, as it is a balanced crystalloid solution with an electrolyte concentration close to that of plasma 1.
• Urine output should be monitored hourly, targeting 0.5-1.0 mL/kg/hour in adults and 1.0-1.5 mL/kg/hour in children, to indicate adequate resuscitation.
• Fluid rates should be adjusted based on clinical response, as some patients may require more or less than the calculated amount, and the infusion rate should be adjusted as soon as possible based on clinical and haemodynamic parameters 1.

Additional Recommendations

• Maintain normothermia, provide adequate pain control, and consider nutritional support early, as burn patients have significantly increased metabolic demands.
• Intravenous access should be obtained as soon as possible, preferably in unburned areas, and an intraosseous route is recommended if intravenous access cannot be rapidly obtained 1.
• Early administration of 20 mL/kg of crystalloid within the first hour is proposed to address the early hypovolaemic phase, with no adjustment for total body surface area (TBSA) due to difficulties in accurately assessing it within the first minutes after injury 1.

From the FDA Drug Label

Burns—After a burn injury (usually beyond 24 hours) there is a close correlation between the amount of albumin infused and the resultant increase in plasma colloid osmotic pressure. The aim should be to maintain the plasma albumin concentration in the region of 2. 5 ± 0.5 g per 100 mL with a plasma oncotic pressure of 20 mm Hg (equivalent to a total plasma protein concentration of 5.2 g per 100 mL). During the first 24 hours after sustaining thermal injury, large volumes of crystalloids are infused to restore the depleted extracellular fluid volume Beyond 24 hours Plasbumin-25 can be used to maintain plasma colloid osmotic pressure.

To determine resuscitation therapy in a burn patient, you use the following factors:

• Plasma albumin concentration: aim to maintain in the region of 2.5 ± 0.5 g per 100 mL
• Plasma oncotic pressure: aim to maintain at 20 mm Hg (equivalent to a total plasma protein concentration of 5.2 g per 100 mL)
• Time since burn injury:
  • First 24 hours: large volumes of crystalloids are infused to restore the depleted extracellular fluid volume
  • Beyond 24 hours: Plasbumin-25 can be used to maintain plasma colloid osmotic pressure 2, 2

From the Research

Determining Resuscitation Therapy in Burn Patients

• The Parkland formula is widely used to determine resuscitation therapy in burn patients, with 69.3% of respondents preferring this method 3.
• Lactated Ringer's (LR) solution is the preferred fluid for resuscitation, used by 91.9% of respondents 3.
• The decision to initiate resuscitation is often based on the percentage of total body surface area (TBSA) burned, with a cutoff of 15% TBSA commonly used 3.
• Urine output is the primary indicator of successful resuscitation, used by 94.9% of respondents 3.
• Resuscitation tables, such as those based on the Parkland formula, can improve the accuracy and ease of calculating fluid requirements 4.
• The use of resuscitation tables can reduce errors in calculating fluid requirements, with accuracy improving to 75% compared to 55% when using the Parkland formula alone 4.
• Other factors, such as the use of colloid solutions and the timing of their administration, can also influence resuscitation therapy in burn patients 3.