From the Guidelines
The Parkland formula for fluid resuscitation in burn patients should be modified if the patient arrives after 6 hours from the time of injury, by calculating the total 24-hour fluid requirement and adjusting the administration schedule to prevent excessive rapid fluid administration. When a patient arrives after 6 hours, the standard Parkland formula (4 mL × patient's weight in kg × % total body surface area burned) is still used to calculate the total 24-hour fluid requirement, but the administration schedule is adjusted to account for the delayed presentation 1. The total calculated fluid volume is administered over a shorter period, with half given over the first 8 hours from the time of presentation and the remaining half over the subsequent 16 hours. For instance, a 70 kg patient with 40% burns presenting 6 hours after injury would require 11,200 mL (4 × 70 × 40) of fluid over 24 hours, with 5,600 mL administered over the first 8 hours after arrival and the remaining 5,600 mL over the next 16 hours. Key considerations in this approach include:
- Using lactated Ringer's solution as the preferred fluid
- Monitoring urine output closely, aiming for 0.5-1 mL/kg/hr
- Adjusting the fluid administration rate as needed to prevent complications such as acute kidney injury and compartment syndrome, which can be exacerbated by delayed or inappropriate fluid resuscitation 1. This modified approach is crucial for optimizing outcomes in burn patients presenting after 6 hours, as it balances the need for adequate fluid resuscitation with the risk of complications associated with excessive or rapid fluid administration.
From the Research
Burns Parkland Formula
The Parkland formula is a widely used method for calculating the amount of fluid required for resuscitation in burn patients. However, its effectiveness and accuracy have been questioned in several studies 2, 3, 4, 5, 6.
Limitations of the Parkland Formula
- The formula may lead to "fluid creep," resulting in complications such as abdominal compartment syndrome 2.
- The formula does not take into account individual patient characteristics, such as age, body mass index (BMI), and percentage of total body surface area (TBSA) affected 3, 5.
- The formula may underestimate or overestimate fluid requirements, leading to under-resuscitation or over-resuscitation 4, 5.
Patient Arrival After 6 Hours
- There is no specific guidance in the provided studies on how to adjust the Parkland formula for patients who arrive after 6 hours.
- However, one study suggests that colloid solutions may be recommended after the third 8 hours post-burn 2.
- Another study recommends initiating resuscitation based on providing 2 mL/kg/% TBSA burn to reduce resuscitation fluid volumes, but does not specify a time frame for patient arrival 6.
Key Findings
- Deviations from the Parkland formula, either positive or negative, are associated with a higher probability of in-hospital mortality 3.
- Exceeding the Parkland formula increases mortality, while under-infusion does not significantly affect mortality 3.
- The Parkland formula remains a useful tool for quick fluid calculations in the acute phase of severe burns, but its limitations should be considered 3, 6.