From the Guidelines
The Parkland formula for pediatric burn resuscitation recommends 4 mL of fluid per kilogram of body weight per percentage of total body surface area (TBSA) burned, to be administered over 24 hours. This formula is used to estimate the fluid requirements for children with burns, taking into account their higher body surface area/weight ratio compared to adults 1. The calculated fluid volume should be given in two halves, with the first half administered in the first 8 hours post-burn and the remaining half over the next 16 hours.
Key Considerations
- The formula helps prevent hypovolemic shock by replacing fluid lost through damaged skin while avoiding overhydration.
- Timing of the formula should start from when the burn occurred, not when treatment begins.
- Urine output should be monitored as an indicator of adequate resuscitation, aiming for 1 mL/kg/hour in children.
- The Parkland formula serves as a starting point, and fluid rates should be adjusted based on the child's clinical response, with particular attention to vital signs, urine output, and mental status.
Calculation Example
- A 20 kg child with 30% TBSA burns would require 2,400 mL of fluid in the first 24 hours (4 mL × 20 kg × 30%). It's essential to note that while the Parkland formula is widely used, its application in children may need to be adjusted based on individual patient needs and response to treatment, as suggested by retrospective studies indicating that reducing total fluid intake levels in certain subgroups of children may be associated with improved outcomes 1.
From the Research
Parkland Formula for Pediatric Burn Resuscitation
The Parkland formula is a widely used method for calculating fluid resuscitation needs in burn patients, including children. The formula is as follows:
- 4 mL/kg/% total body surface area (TBSA) burned, with half of the calculated volume administered in the first 8 hours and the remaining half in the next 16 hours 2, 3, 4, 5
Key Considerations
- The Parkland formula is only a starting point, and fluid resuscitation should be guided by parameters such as urine output and mean arterial pressure 4, 5
- The formula may need to be adjusted based on individual patient needs, such as those with inhalation injuries or larger burns 2
- Colloid supplementation may be necessary in some cases, particularly after the first 8 hours post-burn 2, 6
- The use of a nomogram can facilitate accurate calculation of fluid requirements using the Parkland formula 3
Calculation Methods
- The Parkland formula can be calculated using various methods, including pen and paper, electronic calculator, and nomogram 3
- The nomogram method has been shown to be the most accurate and easiest to use 3