Inflammation increases the capillary protein permeability, leading to fluid shifts that
decrease the circulating volume. Intravenous resuscitation is commenced when the
body surface area burnt exceeds 15% in adults and 10% in children; these thresholds
are rather arbitrary, but correspond to the dividing line between minor and moderately
severe burns. Below the threshold, oral fluids would be expected to be adequate.
The Parklands formula
Resuscitation volume V (ml) 4 BSA (%) body weight (kg)
The calculated volume is given over 24 h: half over 8h and the remainder over
16h. (BSA percentage body surface area burnt)
Maintenance fluids are needed for children.
Most modern formulae are equally effective. They serve only as guides and require
adjustment according to the patient’s response. The single best measure in uncomplicated
burns is the urine output (aim for more than 0.5 ml of urine per hour per kg).
Typically, more fluids are needed with inhalational injuries, electrical burns or for
those with concomitant crush injuries—osmotic diuresis may need to be encouraged
using mannitol. No colloid is necessary in the first 24 h when the capillary permeability
to macromolecules is highest.
Patient monitoring should include blood pressure (insensitive), pulse rate (nonspecific)
and temperature (the core–peripheral gradient can be used to gauge the peripheral
perfusion). If required, the central venous pressure (CVP) and pulmonary capillary
wedge pressure (PCWP) may be measured, but this necessitates invasive monitoring.
decrease the circulating volume. Intravenous resuscitation is commenced when the
body surface area burnt exceeds 15% in adults and 10% in children; these thresholds
are rather arbitrary, but correspond to the dividing line between minor and moderately
severe burns. Below the threshold, oral fluids would be expected to be adequate.
The Parklands formula
Resuscitation volume V (ml) 4 BSA (%) body weight (kg)
The calculated volume is given over 24 h: half over 8h and the remainder over
16h. (BSA percentage body surface area burnt)
Maintenance fluids are needed for children.
Most modern formulae are equally effective. They serve only as guides and require
adjustment according to the patient’s response. The single best measure in uncomplicated
burns is the urine output (aim for more than 0.5 ml of urine per hour per kg).
Typically, more fluids are needed with inhalational injuries, electrical burns or for
those with concomitant crush injuries—osmotic diuresis may need to be encouraged
using mannitol. No colloid is necessary in the first 24 h when the capillary permeability
to macromolecules is highest.
Patient monitoring should include blood pressure (insensitive), pulse rate (nonspecific)
and temperature (the core–peripheral gradient can be used to gauge the peripheral
perfusion). If required, the central venous pressure (CVP) and pulmonary capillary
wedge pressure (PCWP) may be measured, but this necessitates invasive monitoring.
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