Increased fluid resuscitation can lead to adverse outcomes in major-burn injured patients, but low mortality is achievable

Dulhunty, Joel M.; Boots, Robert J.; Rudd, Michael J.; Muller, Michael J.; Lipman, Jeffrey

doi:10.1016/j.burns.2008.01.011

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Volume 34, Issue 8 , Pages 1090-1097, December 2008

Increased fluid resuscitation can lead to adverse outcomes in major-burn injured patients, but low mortality is achievable

Joel M. Dulhunty
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia
- Burns, Trauma & Critical Care Research Centre, University of Queensland, Brisbane, Australia
- Corresponding author. Tel.: +61 7 36368897; fax: +61 7 36363542.
Robert J. Boots
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia
- Burns, Trauma & Critical Care Research Centre, University of Queensland, Brisbane, Australia
Michael J. Rudd
- Burns, Trauma & Critical Care Research Centre, University of Queensland, Brisbane, Australia
- Professor Stuart Pegg Adult Burns Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
Michael J. Muller
- Burns, Trauma & Critical Care Research Centre, University of Queensland, Brisbane, Australia
- Professor Stuart Pegg Adult Burns Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
Jeffrey Lipman
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia
- Burns, Trauma & Critical Care Research Centre, University of Queensland, Brisbane, Australia

Accepted 21 January 2008.

Abstract

Background

Excessive fluid resuscitation of large burn injuries has been associated with adverse outcomes. We reviewed our experience in patients with major-burn injury to assess the relationship between fluid, clinical outcome and cause of variance from expected resuscitation volumes as defined by the Parkland formula.

Methods

Eighty patients with new burns ≥15% total body surface area (TBSA) admitted to the intensive care unit within 48h of injury were included.

Results

Mean fluid volume was 6.0±2.3mL/kg/% TBSA at 24h. Bolus fluids for hypotension and oliguria explained 39% of excess variance from Parkland estimates and inaccurate burn size and weight assessment explained 9% of variance. Higher fluid volume was associated with pneumonia (adjusted odds ratio [AOR]=2.0; 95% confidence interval [CI] 1.2–3.4) and extremity compartment syndrome (AOR=7.9; 95% CI 2.4–26). Colloid use during the first 24h reduced the risk of extremity compartment syndrome (AOR=0.06; 95% CI 0.007–0.49) and renal failure (AOR=0.11; 95% CI 0.014–0.82). In-hospital mortality was low (10%) and not associated with >125% Parkland resuscitation (P=0.39).

Conclusions

Although fluid resuscitation in excess of the Parkland formula was associated with several adverse events, mortality was low. A multi-centre trial is needed to more specifically define the indications and volumes needed for burns fluid resuscitation and revise traditional formulae emphasising patient outcome. Improved training in burn size assessment is needed.

Keywords: Burns, Fluid resuscitation, Hypertonic saline solution, Isotonic solutions, Mortality, Plasma substitutes