For an intubated patient with severe burns receiving fluid resuscitation, which parameter best indicates adequate resuscitation: urine output 0.1 mL/kg/h, mean arterial pressure 45 mmHg, central venous pressure 8 mmHg, or lactate 2 mmol/L?

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Adequate Fluid Resuscitation in Severe Burns

CVP = 8 mmHg (Option C) is the best indicator of adequate fluid resuscitation among the choices provided, though it must be interpreted alongside other parameters rather than in isolation.

Analysis of Each Parameter

Urine Output 0.1 mL/kg/hr (Option A) - INADEQUATE

  • The target urine output for adequate burn resuscitation is 0.5-1 mL/kg/hour in both adults and children 1, 2, 3
  • A urine output of 0.1 mL/kg/hr represents severe oliguria and indicates under-resuscitation with inadequate tissue perfusion 2
  • Urine output is considered the simplest and fastest bedside parameter for adjusting fluid therapy during burn resuscitation 1, 2, 3
  • This value is far below target and signals the need for immediate fluid rate adjustment 1

Mean Arterial Pressure 45 mmHg (Option B) - CRITICALLY LOW

  • The target MAP for adequate perfusion in burn resuscitation is >65 mmHg 2, 4
  • A MAP of 45 mmHg reflects critically low perfusion and may signal insufficient fluid administration 2
  • Persistent hypotension at this level is linked to worse clinical outcomes and requires immediate corrective measures 2
  • This value often necessitates vasopressor support after confirming adequate volume status with echocardiography 1, 3

Central Venous Pressure 8 mmHg (Option C) - ACCEPTABLE RANGE

  • A CVP of 8 mmHg (approximately 8-12 cm H₂O) falls within the acceptable range for guiding fluid resuscitation in burn patients 2, 5
  • CVP should not be used in isolation but must be interpreted together with urine output, MAP, and lactate trends 2
  • Advanced hemodynamic monitoring that includes CVP is especially valuable in patients showing hemodynamic instability or persistent oliguria 1, 2
  • Historical burn resuscitation protocols successfully used CVP targets of 8-12 cm H₂O alongside other clinical parameters 5

Lactate 2 mmol/L (Option D) - MILDLY ELEVATED BUT IMPROVING

  • Early in burn resuscitation, lactate levels are typically elevated (mean ≈ 2.6 ± 2.0 mmol/L) and normalize within 24-32 hours when resuscitation is adequate 2, 4
  • A lactate of 2 mmol/L is mildly elevated but approaching normal and should demonstrate a downward trend with effective fluid therapy 2, 6
  • Lactate clearance to normal values within 24 hours is associated with better survival (68% vs 32% when lactate remains elevated) 6
  • Arterial lactate levels serve as a useful marker of tissue perfusion and adequacy of resuscitation 1, 2, 4

Integrated Monitoring Strategy

The optimal approach to burn fluid resuscitation integrates multiple parameters rather than relying on a single value 2:

  • Primary endpoint: Urine output 0.5-1 mL/kg/hour 1, 2, 3
  • Secondary endpoints: MAP >65 mmHg, CVP 8-12 mmHg, and downward-trending lactate 1, 2, 4
  • Advanced monitoring: Consider echocardiography, cardiac output monitoring, and transpulmonary thermodilution in patients with persistent oliguria or hemodynamic instability 1, 2, 4

Critical Pitfalls

  • Both under-resuscitation (leading to hypoperfusion) and over-resuscitation ("fluid creep") increase morbidity in burn patients 1, 2
  • Fluid infusion rates should be adjusted promptly based on clinical response rather than adhering rigidly to formulaic calculations 1, 2, 3
  • In this scenario, three of the four parameters (A, B, D) indicate inadequate or suboptimal resuscitation, while only CVP falls within an acceptable range 2, 5

References

1
Guideline

Management of Severe Burns

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Fluid Administration in Burn Patients

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

3
Guideline

Burn Patient Management in Intensive Care

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

6
Research

Lactate: early predictor of morbidity and mortality in patients with severe burns.

Burns : journal of the International Society for Burn Injuries, 2005

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