From the Guidelines
The Parkland formula for fluid resuscitation in burn patients is 4 mL of lactated Ringer's solution per kilogram of body weight per percentage of total body surface area (TBSA) burned, with half of the calculated volume given in the first 8 hours and the remaining half over the next 16 hours. This formula is a cornerstone in the initial management of severe burns, as stated in the study published in Anaesthesia in 2020 1. The formula is calculated as follows: 4 mL × body weight (kg) × %TBSA burned. For example, a 70 kg patient with 50% TBSA burns would require 4 mL × 70 kg × 50% = 14,000 mL of fluid in the first 24 hours, with 7,000 mL given in the first 8 hours and 7,000 mL over the next 16 hours. Some key points to consider when using the Parkland formula include:
- The formula only applies to adults with burns greater than 20% TBSA
- The formula should be adjusted based on the patient's response, particularly urine output (target 0.5-1 mL/kg/hr)
- The goal of the formula is to prevent burn shock by replacing fluid lost through damaged capillaries while avoiding overhydration, which can lead to complications like pulmonary edema or compartment syndrome, as discussed in the study 1.
From the Research
Parkland Burn Formula
- The Parkland burn formula is a consensus formula that has excluded colloid use 2
- It is used to calculate the amount of fluid required for resuscitation in burn patients
- The formula is based on the percentage of total body surface area (TBSA) burned and the patient's weight
- However, the use of this formula has been associated with fluid overloading, also known as "fluid creep" 2
Components of the Parkland Burn Formula
- The formula typically involves the administration of crystalloids, such as lactated Ringer's solution
- The amount of fluid administered is usually calculated as 4 mL/kg/%TBSA burned 2
- However, the use of colloids, such as albumin or plasma, has been proposed as an alternative or adjunct to crystalloids 3, 4, 5
Limitations of the Parkland Burn Formula
- The formula has been criticized for leading to fluid overloading and "fluid creep" 2
- The use of colloids has been shown to reduce fluid requirements and limit edema in unburned tissue 4
- However, the optimal treatment of burn shock is still unresolved, and further research is needed to determine the best approach to burn resuscitation 3