From the Guidelines
The preferred fluid for resuscitation of burn patients is lactated Ringer's solution, with albumin considered for patients with a total burned body surface area of over 30% after the first 6 hours of management, at a dose of 1-2 g/kg/day to maintain albumin levels at > 30 g/L 1.
Key Considerations
- For patients with burns covering more than 20% of total body surface area (TBSA), fluid resuscitation should follow the Parkland formula: 4 mL × patient's weight in kg × % TBSA burned, with half given in the first 8 hours from the time of injury and the remaining half over the next 16 hours 2.
- Crystalloid solutions like lactated Ringer's are preferred over colloids in the initial resuscitation phase because burn injury increases capillary permeability, allowing proteins to leak into the interstitial space, which would negate the oncotic advantage of colloids 3.
- Maintenance fluids should be provided alongside resuscitation fluids, and urine output should be monitored as a guide to adequate resuscitation, targeting 0.5-1 mL/kg/hour in adults 4.
- After the first 24 hours, colloids may be considered as capillary integrity begins to restore, and albumin administration has been shown to reduce mortality and abdominal compartment syndrome in severe burns patients 1.
Albumin Administration
- Albumin administration has been shown to reduce mortality and abdominal compartment syndrome in severe burns patients, with a significant reduction in mortality (odds ratio = 0.34; 95% confidence interval = 0.19–0.58; P < 0.001) 1.
- The recommended dose of albumin is 1-2 g/kg/day, to maintain albumin levels at > 30 g/L 1.
- Albumin administration may also reduce the infused volumes of crystalloid and the resulting morbidity, as well as decrease the incidence of organ failure and mortality for patients with a TBSA of 20–30% 1.
From the Research
Fluid Choice for Resuscitation of Burn Patients
The choice of fluid for resuscitation of burn patients is a critical aspect of their care. The following points highlight the key findings related to fluid choice:
- The Parkland formula is widely used for fluid resuscitation in burn patients, but it has been questioned in recent studies 5.
- The use of colloid, such as albumin, has been shown to normalize resuscitation ratios and ameliorate "fluid creep" in adult burn patients 6.
- Similar results have been observed in pediatric burn patients, where the addition of colloid restores normal resuscitation ratios 7.
- Hypertonic fluids, such as hypertonic lactate saline, have also been used in some burn centers to maintain plasma volume without infusing larger fluid volumes 8.
- The effectiveness of the Parkland formula in estimating resuscitation fluid volume has been questioned, with some studies showing significant differences between actual and calculated fluid volumes 5.
Key Considerations
Some key considerations when choosing a fluid for resuscitation of burn patients include:
- The need to maintain urine output and prevent "fluid creep" 6, 7.
- The potential benefits of using colloid, such as albumin, to normalize resuscitation ratios 6, 7.
- The use of hypertonic fluids, such as hypertonic lactate saline, to maintain plasma volume without infusing larger fluid volumes 8.
- The importance of individualizing fluid resuscitation based on patient response and urine output 5.