Fluid resuscitation in burn

1. Dr. HARSH AMIN

2. Introduction

 Before 1940s hypovolemic
shock was the leading cause
of death after burn injury
 Now the mortality due to
hypovolemic shock is
decreased after use of various
fluid resuscitation formulas.
 But still 50% burn deaths
occurring in first 10 days are
mainly due to inadequate and
inappropriate fluid
resuscitation management.

3. Phases of management of burn injury

4. Burn Resuscitation

 Burns shock
-patho-physiology
 Burns shock resuscitation
-standard resuscitation methods
-problems and complications with resuscitation

5. Burn shock

Mechanism is still not clear

6. Patho-physiology

NORMAL BLOOD
CAPILLARY
POSTBURN BLOOD
CAPILLARY
Water molecule
Water is the smallest molecule that can
pass through the capillary pores.
Protein molecule
Permeability is increased, which allows
large molecules such as proteins to pass
through the capillary pores easily.

9. Resuscitation

It begins with arrival of patient

10. Secure I.V. Line


11. Weight of Patient


12. Estimation of Size of
Burn


13. Start Resuscitation


14. Secure an IV Line

A challenging task in burns patient

15. Difficult to Secure IV Line


16. Maximal Sterile Barriers


17. Peripheral Line


18. Peripherally inserted
central catheter


19. Cental Venous Line


20. Venous Cut-Down


21. Estimation of Size of
Burn

Overestimated in inexperienced hand

23. Other Formulas


24. Fluid Resuscitation Protocol

Goal: Restore and Preserve tissue perfusion to avoid
ischemia

25. Resuscitation Solutions
Crystalloids- RL,
d5%, NS,
Hypertonic Saline
Colloids-
Albumin, Dextran,
Hetastarch

26. Most Preferred Solution

 Most Preferred Fluid → Ringer Lactate( RL )
Na+ conc most free of converted
130mEq/L physiological Glucose to HCO3

27. Resuscitation Formulas

CRYSTALLOID C O L L O I D H Y P E R T O N I C
SALINE
DEXTRAN
Parkland Evan’s Monafo Demling
Modified Brooke Brooke Warden
Slater
None is absolute — ultimate resuscitation is conditional

28. Most Preferred Formula


29. Fluid Resuscitation in

 fluid requirements for children averaged
5.8 cc/kg/% burn.
 Which equals
parkland formula + maintenance fluid
4 mL/ kg × % TBSA burn + 1500 cc/m2 BSA
for 24 h
Pediatric Patient

30. Formula For Pediatric Burn


31.  In massive burns , child and inhalational injury cases
combination of fluid is used to “minimize edema”
 Where- calculate by parkland formula and --->
1st 8 hr RL + 50 mEq
NaHCO3
hypertonic
2nd 8 hr RL -
3rd 8 hr RL+ 5% albumin hyperosmolar

32. Monitoring

No resuscitation formula is a license to put the burns
patient on AUTO PILOT

33.  Cardiovascular-
B.P./ECG/heart rate
 Renal- urine output
U.O.-Adult- 30-50 ml/hr
- child(<30kg)-0.5-1 ml/kg/hr

34. When does resuscitation
complete ???

 When No more accumulation of edema fluid
(18 – 30 hrs post burn)
 Resuscitation fluid require till
Volume required to maintain U.O. at 30-50 ml/hr
equals Maintenance volume

35. “Fluid Creep”-over resuscitation

Most common disadvantage with parkland’s
formula
Sequelae:
 Skin edema
 Compartment syndrome
 Pulmonary & Cerebral edema
 ARDS / MOD
 ↑ costs, ↑mortality

36. Avoiding “the creep”

Avoid early over resuscitation (accurate initial
burn estimation)
Early institution of colloid ( colloid rescue )
Changing Resuscitation protocols

37. Failure of Resuscitation

 Extreme age
 Extensive burns
 Major electrical injury
 Major inhalational injury
 Initial delay in initializing fluid
 Underlying disease that limits metabolic or cardiac
reserve

38. Innovations


39. Innovations


40. Thank 
you
for your
attention