A lesson from Beyond the Burn: Navigating Modern Burn Care

Fluid Resuscitation Efficacy in Burn Cases

Numerous factors beyond the extent of burn involvement influence fluid requirements during resuscitation. These include burn depth, inhalation injury, associated injuries, age, delay in resuscitation, need for escharotomies/fasciotomies, and the use of alcohol or drugs. It's clear that these formulas merely serve as initial guides for determining fluid resuscitation rates. Fluid resuscitation, regardless of the solution employed or estimated needs, must be tailored to maintain a urine output of approximately 0.5–1.0 ml/kg/hour in adults and 1.0–1.5 ml/kg/hour in children. Utilize an indwelling bladder catheter (e.g., Foley catheter) for monitoring. Assess clinical signs of volume status hourly for the initial 24 hours, including heart rate, blood pressure, pulse pressure, distal pulses, capillary refill, and the color and turgor of uninjured skin. Diminished distal pulses in newly burned patients are often attributable to inadequate fluid resuscitation. A decline in mixed venous oxygen saturation and an increase in serum lactate indicate insufficient end-organ perfusion.
Endpoint or signTarget or interpretation
Urine output, adultsApproximately 0.5–1.0 mL/kg/hour
Urine output, childrenApproximately 1.0–1.5 mL/kg/hour
Monitoring methodIndwelling bladder catheter
Clinical signsHeart rate, blood pressure, pulse pressure, distal pulses, capillary refill, and color and turgor of uninjured skin, checked hourly for the first 24 hours
Diminished distal pulsesCommon in newly burned patients and usually reflects inadequate fluid resuscitation
Falling mixed venous oxygen saturationSuggests insufficient end-organ perfusion
Rising serum lactateSuggests insufficient end-organ perfusion
Factors influencing fluid requirementsBurn depth, inhalation injury, associated injuries, age, delayed resuscitation, escharotomy or fasciotomy, and alcohol or drug use

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