Fluid Management in Burn Patients

Initial Resuscitation Formulas

The American Burn Association recommends the Parkland formula, which suggests 2-4 mL/kg/%TBSA of fluid in the first 24 hours, with half of the calculated volume administered in the first 8 hours and the rest in the following 16 hours 1, 3
Other available formulas include Evans, Brooke, and the Rule of Tens, with the latter being more suitable for prehospital care 1
None of these formulas have been rigorously validated, and none have demonstrated better outcomes than the others 1, 2

Children have a higher surface area-to-weight ratio than adults, requiring a higher fluid intake 1, 2
For burns >10% TBSA in children, a modified Parkland formula (3-4 mL/kg/%TBSA) is recommended, with additional calculation of basal requirements using the 4-2-1 rule of Holliday and Segar 1, 2, 3
Retrospective studies show that burned children require approximately 6 mL/kg/%TBSA in the first 48 hours 1, 3

The initial fluid estimate should be adjusted based on clinical response, with the simplest and fastest method being hourly urine production, aiming for 0.5-1 mL/kg/h 1, 2
Other useful parameters include arterial lactate concentration and advanced hemodynamic monitoring (echocardiography, cardiac output, central venous pressure) 1, 2
It is crucial to avoid both under-infusion and over-infusion ("fluid creep"), as both increase morbidity 1

Adults with burns ≥10% TBSA require fluid resuscitation 4
Children with burns ≥5% TBSA require fluid resuscitation 4
Burns involving the face, hands, feet, genitals, or those with full-thickness compromise, regardless of size, require fluid resuscitation 4, 5

If hypotension persists despite adequate fluid resuscitation, vasopressors may be used, but cardiac function and intravascular volume status should be evaluated 1, 2

Using computer-based decision support systems to limit the risk of over-resuscitation can be beneficial 1, 2