From the Guidelines
The Parkland formula for burn resuscitation 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 administered 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 it helps estimate fluid requirements and prevent both under-resuscitation and over-resuscitation 1. The formula is calculated as 4 mL × weight (kg) × %TBSA burned, and it is essential to adjust fluid administration based on the patient's response, particularly urine output, to ensure optimal outcomes.
Key Considerations
- The Parkland formula provides an initial estimate of fluid requirements, but it is crucial to monitor the patient's response and adjust fluid administration accordingly 1.
- Burn injuries cause massive fluid shifts due to increased capillary permeability and inflammatory mediator release, requiring prompt and adequate fluid replacement to maintain tissue perfusion and prevent complications.
- The formula is not formally validated, but it is widely used in clinical practice to guide fluid resuscitation in burn patients 1.
- In children, the formula may need to be adjusted due to their higher body surface area/weight ratio, and some centers use a modified Parkland formula in combination with Holliday and Segar's 4-2-1 rule to calculate daily basal fluid intake requirements 1.
Calculation Example
- A 70 kg patient with 50% TBSA burns would require 14,000 mL (4 mL × 70 kg × 50%) in the first 24 hours, with 7,000 mL administered in the first 8 hours and the remaining 7,000 mL over the next 16 hours.
- It is essential to note that this formula provides only an initial estimate, and fluid administration should be adjusted based on the patient's response, particularly urine output (target 0.5-1.0 mL/kg/hr in adults) 1.
From the Research
Parkland Formula Overview
- The Parkland formula is a standard method for calculating the initial intravenous fluid rate for resuscitation after thermal injury 2, 3, 4, 5, 6
- It is used to guide fluid resuscitation in burn patients, taking into account the patient's weight and the percentage of total body surface area burned
Formula Calculation
- The formula calculates the total amount of fluid required for the first 24 hours, with half of the fluid administered in the first 8 hours and the remaining half in the next 16 hours 4
- The formula is: 2-4 mL/kg/burned area of total body surface area % 5
Clinical Application
- The Parkland formula is widely used in clinical practice, but its application can be cumbersome for those with modest burn training 2
- Graphic aids, such as nomograms and slide rules, have been developed to simplify the calculation of fluid resuscitation requirements using the Parkland formula 6
- Studies have shown that the use of these graphic aids can improve the accuracy of fluid resuscitation calculations 2, 6
Variations and Controversies
- Some studies have suggested that the Parkland formula may not always provide adequate fluid resuscitation, and that larger volumes of fluid may be required in some cases 3
- Other studies have investigated the use of central circulatory endpoints, such as urine output and mean arterial pressure, to guide fluid resuscitation 5