What is the initial recommendation for burn fluid management?

From the Guidelines

The initial recommendation for burn fluid management is to administer 20 mL/kg of an intravenous crystalloid solution within the first hour of management for adult burn patients with a total burned body surface area of % and paediatric burn patients with a total burned body surface area of 10%. This approach is based on the most recent and highest quality study available, which suggests the use of balanced crystalloid solutions for initial fluid resuscitation 1. The goal of fluid resuscitation is to restore intravascular volume, maintain tissue perfusion, and prevent burn shock.

Some key points to consider in burn fluid management include:

• The use of balanced crystalloid solutions, such as lactated Ringer's solution, as the initial fluid of choice for resuscitation 1
• The importance of titrating fluid resuscitation to maintain adequate urine output, with targets of 0.5-1.0 mL/kg/hr in adults and 1.0-1.5 mL/kg/hr in children
• Regular monitoring of vital signs, urine output, and mental status to prevent both under-resuscitation and fluid overload
• The potential need for adjustments to the initial fluid resuscitation plan based on individual patient response, with consideration of factors such as age, comorbidities, and severity of burn injury

It is also worth noting that while the Parkland formula is a commonly used approach for calculating fluid requirements in burn patients, the most recent and highest quality study available suggests a more simplified approach, with administration of 20 mL/kg of crystalloid solution within the first hour of management 1. Additionally, the use of albumin in burn fluid management is a topic of ongoing debate, with some studies suggesting potential benefits in reducing morbidity and mortality, but others raising concerns about the quality of evidence and potential risks 1.

Overall, the key principle in burn fluid management is to prioritize individualized care, with careful monitoring and adjustment of fluid resuscitation to meet the unique needs of each patient, and to prioritize the use of balanced crystalloid solutions as the initial fluid of choice for resuscitation 1.

From the Research

Burn Fluid Management

• The initial recommendation for burn fluid management is the use of the Parkland formula, which is a crystalloid-based formula that guides fluid therapy 2, 3, 4, 5, 6.
• The Parkland formula calculates the initial intravenous fluid rate for resuscitation after thermal injury, with the goal of providing adequate fluid to support the patient's needs without over-resuscitating 3, 4, 6.
• However, studies have shown that patients often receive more fluid than predicted by the Parkland formula, which can lead to adverse consequences such as worsening of burn oedema, conversion of superficial into deep burns, and compartment syndromes 2, 4, 6.
• Alternative methods, such as the Burn Resuscitation Index (BRI), have been proposed to simplify the calculation of fluid requirements and improve accuracy 3.
• The use of hypertonic Ringer acetate may also reduce fluid requirements and edema generation 5.
• Ultimately, the key to effective burn fluid management is to monitor the patient's response to fluid therapy and adjust the treatment plan accordingly, with emphasis on parameters such as urine output (UOP) per hour 6.

Key Considerations

• The Parkland formula should be used as a starting point for resuscitation, rather than a rigid guideline 6.
• Fluid therapy should be adjusted to individual requirements, taking into account factors such as burn size, depth, and location, as well as the patient's overall condition 2, 4, 5.
• Monitoring of UOP and other parameters is crucial to guide resuscitation and avoid over-resuscitation 6.