What should the Lactated Ringer's (LR) drip rate be for a patient with 30% burns?

From the Guidelines

For a patient with 30% burns, the recommended Lactated Ringer's (LR) drip rate should follow the Parkland formula: 4 mL × patient's weight in kg × percentage of body surface area burned, with half given in the first 8 hours and the remainder over the next 16 hours. For example, in a 70 kg patient with 30% burns, the total fluid requirement would be 4 mL × 70 kg × 30% = 8,400 mL for the first 24 hours 1. The initial drip rate would be 525 mL/hour for the first 8 hours (4,200 mL ÷ 8 hours), followed by 262.5 mL/hour for the next 16 hours (4,200 mL ÷ 16 hours). This aggressive fluid resuscitation is crucial to prevent burn shock by replacing fluid lost from the circulation due to increased capillary permeability, as supported by the management of severe thermal burns in the acute phase in adults and children study published in Anaesthesia in 2020 1.

Key Considerations

• Urine output should be monitored as a guide to adequate resuscitation, targeting 0.5-1 mL/kg/hour 1.
• The formula provides an initial guideline, but the rate should be adjusted based on the patient's clinical response, vital signs, and urine output.
• The use of colloids, such as human albumin, may be considered in the early phase of severe burn management, but their effectiveness and safety are still being debated 1.

Adjusting Fluid Resuscitation

The experts suggest that in fluid resuscitation for severe burns, the infusion rate should be adjusted as soon as possible based on clinical and haemodynamic parameters 1. This approach allows for a more personalized and effective management of burn shock, reducing the risk of complications and improving patient outcomes.

Monitoring and Adjustment

Regular monitoring of the patient's vital signs, urine output, and clinical response is essential to adjust the fluid resuscitation rate accordingly. This may involve increasing or decreasing the drip rate, as well as considering the use of other fluids or interventions, such as colloids or vasopressors, to support the patient's hemodynamic stability. By prioritizing the patient's clinical response and adjusting the fluid resuscitation rate accordingly, healthcare providers can optimize the management of severe burns and improve patient outcomes.

From the Research

Lactated Ringer's (LR) Drip Rate for a Patient with 30% Burns

To determine the appropriate Lactated Ringer's (LR) drip rate for a patient with 30% burns, we can refer to the Parkland formula, which is widely used in burn resuscitation. The formula recommends administering 2 mL/kg/%TBSA of LR solution in the first 24 hours after the burn injury, with half of the total volume given in the first 8 hours and the remaining half given over the next 16 hours 2.

Calculating the LR Drip Rate

Using the Parkland formula, the total volume of LR solution to be administered in the first 24 hours can be calculated as follows:

• Total volume = 2 mL/kg/%TBSA x weight (kg) x %TBSA
• For a patient with 30% burns and a weight of 70 kg (assuming an average adult weight), the calculation would be:
  • Total volume = 2 mL/kg/%TBSA x 70 kg x 30% = 4200 mL

Drip Rate Calculation

To calculate the drip rate, we need to divide the total volume by the time over which it will be administered. According to the Parkland formula, half of the volume (2100 mL) should be given in the first 8 hours, and the remaining half in the next 16 hours.

• Drip rate for the first 8 hours = 2100 mL / 8 hours = 262.5 mL/hour
• Drip rate for the next 16 hours = 2100 mL / 16 hours = 131.25 mL/hour

Adjustments Based on Urine Output

It's crucial to adjust the drip rate based on the patient's urine output, aiming for 0.5 to 1 mL/kg/hour of urine production 3, 4. This may require titrating the LR drip rate to achieve the desired urine output, indicating adequate fluid resuscitation and end-organ perfusion.

Consideration of Colloid Supplementation

Some studies suggest the use of colloid supplementation, such as albumin, in burn resuscitation, especially for patients with larger burns or those who are not responding adequately to crystalloid resuscitation alone 5, 6. However, the decision to add colloid should be made based on individual patient response and institutional protocols.

Summary of Key Points

• The Parkland formula provides a guideline for the initial fluid resuscitation in burn patients.
• The LR drip rate should be calculated based on the patient's weight and percentage of burns.
• Adjustments to the drip rate should be made based on urine output to ensure adequate fluid resuscitation.
• Consideration of colloid supplementation may be necessary in certain cases, as guided by patient response and institutional protocols 3, 5, 4, 2, 6.