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Burn Resuscitation

DOI: 10.1186/1757-7241-19-69

Keywords: Burn resuscitation, Crystalloid, Colloid

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Abstract:

One of the most challenging aspects of caring for burned patients is the acute resuscitation. The profound inflammatory response generated by a burn far surpasses that seen in trauma or sepsis, and the resultant fluid needs can be extreme. There is a large and ever-increasing body of research devoted to refining strategies for acute burn resuscitation, and this article attempts to summarize some the most important recent findings in the field.After treating victims of the infamous Coconut Grove fire in 1942, Cope and Moore first postulated that burn resuscitation needs may have contributions from both the patient's body weight and the size of their burn [1]. Baxter and Shires later built on this knowledge, using canine and human data, to specifically measure fluid requirements by weight and total body surface area (%TBSA). Their formula of 3.5 to 4.5 ml of lactated Ringers per %TBSA per kilogram became known as the Parkland formula after the Dallas medical complex in which their experiments took place [2]. Although the Parkland formula is still the most commonly employed resuscitation formula worldwide, it is far from a perfect solution.Ongoing research focuses on refining existing formulas to prevent complications of over-resuscitation. This includes devising novel means for titrating resuscitation, such as nurse-driven or computer-driven protocols. The composition of the fluids used in resuscitation has generated significant interest, with a particular focus on colloids and hypertonic saline. Pharmaceutical therapies that attempt to down regulate the inflammatory response such as vitamin C may have a role in acute resuscitation. Likewise, investigators are proposing the use of adjuncts such as plasmapheresis to remove inflammatory mediators from the bloodstream during resuscitation. The final topic inviting significant scrutiny is outcomes of resuscitation, both choosing the most appropriate outcomes to use and how to best measure these outcomes in clinical practi

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