From the Guidelines
The Rule of 10 for fluid resuscitation in burn patients is not a clinically validated formula, and its use is not recommended in favor of other established formulae such as the Parkland formula, which estimates fluid requirements between 2 and 4 mL/kg/%TBSA over the first 24 hours post-burning 1.
Background and Rationale
The management of severe thermal burns requires careful fluid resuscitation to prevent burn shock and support the patient's hemodynamic stability. Several formulae have been developed to predict fluid requirements, including the Evans, Baxter and Shires (Parkland formula), and Pruitt et al. (Brooke formula) 1.
Clinical Application
In clinical practice, the Parkland formula is commonly used, which calculates the total fluid requirement as 4 mL/kg/%TBSA burned over the first 24 hours, with half of this volume administered in the first 8 hours and the remaining half over the next 16 hours 1. For example, a 70 kg patient with 50% TBSA burns would require 4 mL × 50% × 70 kg = 14,000 mL (14 liters) of fluid over the first 24 hours.
Monitoring and Adjustment
Adequate fluid resuscitation is crucial, and urine output should be monitored closely, aiming for 0.5-1 mL/kg/hr in adults, to assess the adequacy of resuscitation 1. The fluid rate may need adjustment based on the patient's response, and individualized adjustments are often necessary based on the patient's clinical status.
Special Considerations in Children
In children, the calculation of fluid requirements differs due to their higher body surface area/weight ratio, and several formulae have been proposed, including the modified Parkland formula and the Holliday and Segar’s 4-2-1 rule 1. However, reducing total fluid intake levels in children with 10–20% of burned TBSA has been associated with a shorter hospital stay and a lesser need for skin grafts 1.
From the Research
Rule of 10 for Fluid Resuscitation in Burn Patients
- The "rule of 10" is a simplified method for deriving the initial fluid rate for burn resuscitation, as described in a study published in 2010 2.
- This rule is designed to provide an initial fluid rate that falls within acceptable ranges for the majority of adult burn patients.
- The study found that the rule of 10 approximated the initial fluid rate within acceptable ranges for 87.8% of patients, with less than 12% of patients having initial rates below the modified Brooke formula and less than 1% having initial rates above the Parkland formula.
- The rule of 10 is not explicitly defined in the provided studies, but it is mentioned as a method for simplifying the process of estimating initial fluid rates for burn resuscitation.
Comparison with Other Fluid Resuscitation Formulas
- The rule of 10 is compared to other fluid resuscitation formulas, such as the modified Brooke and Parkland formulas, in the 2010 study 2.
- Another study published in 2021 compares a simplified fluid resuscitation formula for burns in mass casualty scenarios with current guidelines, including the 2-4 mL/kg/%TBSA formula for adults and the Galveston formula for children 3.
- The American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation, published in 2024, recommend initiating resuscitation based on providing 2 mL/kg/% TBSA burn to reduce resuscitation fluid volumes 4.
Limitations and Future Directions
- The provided studies do not fully define the rule of 10 or its application in clinical practice.
- Further research is needed to fully understand the rule of 10 and its potential benefits and limitations in burn resuscitation.
- The use of hypertonic fluids, plasma, and other resuscitation strategies are discussed in other studies, but their relationship to the rule of 10 is not explicitly stated 5, 6.