Hemodynamic changes during resuscitation after burns using the Parkland formula

Area of Science:

• Critical Care Medicine
• Trauma Surgery
• Burn Management

Background:

• The Parkland formula is a standard for burn fluid resuscitation, using urine output and mean arterial pressure (MAP).
• Debate exists regarding central circulatory endpoints and fluid volumes.
• Limited hemodynamic data exist for correct Parkland formula application.

Purpose of the Study:

• To evaluate cardiovascular coupling using central hemodynamic monitoring in burn patients treated with the Parkland formula.
• To assess if fluid resuscitation guided by urine output and MAP is adequate.

Main Methods:

• Ten burn patients (>20% total body surface area) were monitored at 12, 24, and 36 hours post-injury.
• Transesophageal echocardiography, pulmonary artery catheterization, and transpulmonary thermodilution were employed.
• Central hemodynamic variables were assessed alongside traditional endpoints.

Main Results:

• Oxygen transport, heart rate, MAP, and left ventricular function showed no significant changes during resuscitation.
• Left ventricular volumes normalized by 24 hours post-burn.
• Elevated extravascular lung water to intrathoracic blood volume ratio was noted at 12 hours.

Conclusions:

• Central hemodynamic monitoring indicated no need to increase total fluid volume within 36 hours.
• Early signs of central hypovolemia at 12 hours suggest a need for more rapid initial fluid infusion.
• The Parkland formula, with adjustments for early fluid delivery, remains a viable resuscitation strategy.