Burn resuscitation

Leopoldo C. Cancio, Fredrick J. Bohanon, George C. Kramer

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

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.

Original languageEnglish (US)
Title of host publicationTotal Burn Care
Subtitle of host publicationFifth Edition
PublisherElsevier Inc.
Pages77-86.e2
ISBN (Electronic)9780323497428
ISBN (Print)9780323476614
DOIs
StatePublished - Jan 1 2018

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Keywords

  • Albumin
  • Ascorbic acid
  • Burns
  • Edema
  • Fluid resuscitation
  • Lactated Ringer's solution
  • Shock

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Cancio, L. C., Bohanon, F. J., & Kramer, G. C. (2018). Burn resuscitation. In Total Burn Care: Fifth Edition (pp. 77-86.e2). Elsevier Inc.. https://doi.org/10.1016/B978-0-323-47661-4.00009-5