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 this 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 estimates fluid requirements between 2 and 4 mL/kg/%TBSA over the first 24 hours post-burning.
Calculation and Administration
To calculate the total fluid requirement, the formula is applied 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. Half of this volume, 7,000 mL, is administered in the first 8 hours after the burn injury, and the remaining 7,000 mL is given over the next 16 hours.
Adjustments and Considerations
It's crucial to adjust the actual fluid administration based on the patient's response, particularly urine output, which should be targeted at 0.5-1 mL/kg/hr. The Parkland formula helps prevent both under-resuscitation, which can lead to shock and organ failure, and over-resuscitation, which can cause pulmonary edema and compartment syndromes. Although the formula has not been formally validated, it remains a widely accepted guideline for initial fluid resuscitation in burn patients, as noted in the 2020 study published in Anaesthesia 1.
Key Points
- The Parkland formula calculates the total fluid requirement for the first 24 hours after a burn injury.
- The formula is 4 mL of lactated Ringer's solution per kilogram of body weight per percentage of total body surface area (TBSA) burned.
- Half of the calculated volume is given in the first 8 hours, and the remaining half is given over the next 16 hours.
- Adjustments should be made based on the patient's response, particularly urine output.
From the Research
Parkland Burn Formula
- The Parkland formula is a method for determining the amount of fluid necessary for burn patients, although it is not strictly followed or used in current practice 2.
- The formula is used for quick fluid calculations in the acute phase of severe burns 2.
- Deviations from the calculated amount are very common, with a higher incidence of over-infusion, and exceeding the Parkland formula increases mortality while under-infusion does not significantly affect mortality 2.
Key Points
- The Parkland formula remains a useful tool for quick fluid calculations in the acute phase of severe burns 2.
- The optimal treatment of burn shock is still unresolved, and the problem of "fluid creep" continues despite modern devices that fail to improve outcomes over hourly urine output 3.
- Colloids, especially albumin, reduce fluid requirements and can be used either immediately at the start of resuscitation or as a "rescue" when crystalloid use is excessive 3, 4.
Fluid Resuscitation
- Fluid resuscitation after a burn injury is one of the crucial aspects of acute therapy 2.
- Crystalloid administration during early resuscitation of bleeding trauma patients is recommended by current guidelines, yet evidence supporting this practice is limited 5.
- The administration of ≥2 liters of crystalloids during the initial phase of care was independently associated with increased mortality in hemodynamically compromised trauma patients 5.