From the Guidelines
The Parkland formula for pediatric burn patients is 4 mL × weight (kg) × % total body surface area (TBSA) burned, with half given in the first 8 hours and the remainder over the next 16 hours, and for children, additional maintenance fluids must be added to this calculation, following the 4-2-1 rule. When calculating the total fluid intake required in the first 48 hours for children, several formulae have been proposed, all including TBSA, but none have been formally evaluated or compared 1. The 4-2-1 rule is used to calculate the daily basal fluid intake requirement for children, which is then added to the fluid requirement determined by the modified Parkland formula, between 3 and 4 mL/kg/%TBSA 1. Key considerations in pediatric burn resuscitation include:
- Accurate weight and burn size assessment, with the modified Lund and Browder chart preferred for children as it accounts for age-related body proportion differences
- Use of lactated Ringer's solution for both resuscitation and maintenance fluids
- Maintenance of urine output at 1 mL/kg/hr in children under 30 kg and 0.5-1 mL/kg/hr in larger children, as the primary indicator for adequate fluid resuscitation
- Adjustment of fluid rates based on the child's clinical response, given children's limited physiological reserve and potential for rapid deterioration with inadequate resuscitation 1. It is essential to note that reducing total fluid intake levels in children with 10–20% of burned TBSA may be associated with a shorter hospital stay and a lesser need for skin grafts, as suggested by two retrospective studies 1.
From the Research
Parkland Formula for Pediatric Burn Resuscitation
The Parkland formula is a widely used protocol to guide fluid resuscitation of acute burns, including pediatric cases. The formula is used to calculate the amount of fluid required for resuscitation in the first 24 hours after a burn injury.
Formula Calculation
- The Parkland formula calculates the total amount of fluid required as 4 mL/kg/% total body surface area (TBSA) burned [ 2, 3,4,5 ]
- The formula is often adapted for pediatric use, taking into account the child's weight and the percentage of TBSA burned [ 2, 3,4 ]
- The calculated fluid volume is usually administered over the first 24 hours, with half of the volume given in the first 8 hours and the remaining half given over the next 16 hours [ 2, 3,4,5 ]
Clinical Application
- The Parkland formula is widely used in clinical practice to guide fluid resuscitation in pediatric burn patients [ 2, 6,3,4,5 ]
- However, some studies have reported deviations from the calculated fluid volume, with some patients receiving more or less fluid than predicted by the formula [ 6, 5 ]
- The use of graphic aids, such as nomograms, can help simplify the calculation of fluid requirements and reduce errors [ 3, 4 ]
Key Points
- The Parkland formula is a widely used protocol for fluid resuscitation in pediatric burn patients
- The formula calculates the total amount of fluid required based on the child's weight and percentage of TBSA burned
- The calculated fluid volume is usually administered over the first 24 hours, with half given in the first 8 hours and the remaining half given over the next 16 hours
- Deviations from the calculated fluid volume may occur in clinical practice, and graphic aids can help simplify calculations and reduce errors [ 2, 6,3,4,5 ]