Burn resuscitation

Large burns cause fluid extravasation and hypovolemia. Diligent volume replacement is needed during the first 1-2 days post burn. The seminal discovery was that the main physiological deficit in burn shock is hypovolemia, which led to treatment using plasma. Subsequent studies by Baxter and Pruitt reported effective resuscitation with crystalloids alone. This resulted in the practice of infusing lactated Ringer's solution at initial rates based on formulas incorporating body weight and burn size. Resuscitation is then titrated to physiologic endpoints. Modern burn centers use multiple endpoints to optimize volume support, including urinary output, blood pressure, heart rate, hematocrit, and blood lactate levels. Most recently the term "fluid creep" has been used to describe the occurrence of overresuscitation and its complications. While the reasons for fluid creep are multifactorial, several approaches are being advocated to moderate fluid input, including earlier use of albumin, high-dose ascorbic acid, and protocolized or computerized decision support.