In a patient with extensive burns who has been intubated and resuscitated, which of the following best indicates adequate fluid resuscitation: urine output 0.1 mL/kg/h, mean arterial pressure 45 mm Hg, central venous pressure 8 mm Hg, or lactate 2 mmol/L?

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Last updated: February 16, 2026 • View editorial policy

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Adequate Fluid Resuscitation in Burn Patients

CVP = 8 mm Hg (Option C) is the best indicator of adequate fluid resuscitation among these choices, though it should ideally be combined with urine output monitoring targeting 0.5-1 mL/kg/h.

Analysis of Each Option

Option A: Urine Output 0.1 mL/kg/h - INADEQUATE

  • This urine output is severely inadequate and indicates under-resuscitation 1, 2
  • The target urine output during burn resuscitation should be 0.5-1 mL/kg/h in both adults and children 1, 2, 3
  • Urine output is considered the easiest and fastest parameter to guide fluid resuscitation adjustments 1, 2
  • A urine output of only 0.1 mL/kg/h represents oliguria and signals inadequate tissue perfusion 1

Option B: MAP = 45 mm Hg - INADEQUATE

  • A MAP of 45 mm Hg is critically low and indicates inadequate perfusion 1
  • The target MAP during burn resuscitation should be >65 mm Hg 4
  • This level of hypotension despite resuscitation suggests either insufficient fluid administration or the need for vasopressor support 1
  • Persistent hypotension is associated with worse outcomes and requires immediate intervention 1

Option C: CVP = 8 mm Hg - ADEQUATE

  • A CVP of 8 mm Hg falls within the acceptable range of 8-12 cm H₂O used to guide burn resuscitation 5
  • This represents adequate central venous filling pressure when combined with other clinical parameters 5
  • However, CVP alone should not be the sole endpoint - it must be interpreted alongside urine output, MAP, and lactate 1, 4
  • Advanced hemodynamic monitoring including CVP can be particularly valuable in patients with hemodynamic instability or persistent oliguria 1

Option D: Lactate 2 mmol/L - BORDERLINE/ACCEPTABLE

  • A lactate of 2 mmol/L is mildly elevated but approaching normal range 4
  • During early burn resuscitation, lactate levels are typically elevated (mean 2.58 ± 2.05 mmol/L) and normalize by 24-32 hours with adequate resuscitation 4
  • Lactate is a useful marker of tissue perfusion and should be used in combination with other parameters 1, 4
  • Lactate levels should be optimized and trending downward with adequate resuscitation 4

Optimal Monitoring Strategy

The best approach combines multiple parameters rather than relying on a single value 1, 4:

  • Primary endpoint: Urine output 0.5-1 mL/kg/h 1, 2
  • Secondary endpoints:
    • MAP >65 mm Hg 4
    • CVP 8-12 cm H₂O 5
    • Normalizing lactate levels 4
    • Cardiac index >2.5 L/min/m² (if advanced monitoring available) 4

Critical Pitfalls to Avoid

  • Do not rely solely on urine output and vital signs, as they may not reflect adequate central hemodynamic status 4, 6
  • Avoid both under-resuscitation and over-resuscitation ("fluid creep"), as both increase morbidity 1, 2
  • Early signs of central circulatory hypovolemia may be present at 12 hours despite normal blood pressure and urine output, supporting more rapid initial fluid infusion 6
  • Adjust fluid rates promptly based on clinical response rather than rigidly following formulas 1, 2

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Fluid Administration in Burn Patients

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

3
Guideline

Emergency Management of Pediatric Burn Patients

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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