[Estimation of substitution volume after burn trauma. Systematic review of published formulae]

Fluid resuscitation after severe burns remains a challenging task particularly in the preclinical and early clinical phases. To facilitate volume substitution after burn trauma several formulae have been published and evaluated, nevertheless, the optimal formula has not yet been identified.

A systematic PubMed search was performed to identify published formulae for fluid resuscitation after severe burns. The search terms "burn", "thermal", "treatment", "therapy" or "resuscitation", "fluid", "formula" and "adult", "pediatric" or "paediatric" were used in various combinations. Analysis was limited to the period from 01.01.1950 to 30.06.2010 and database entries in PubMed (http://www.pubmed.com). Additionally, references cited in the papers were analyzed and relevant publications were also included. Publications and formulae were assessed and classified by two independent investigators.

Within the specified time frame eight publications (five original contributions and three book chapters) were identified of which three formulae recommended colloid solutions, four recommended electrolyte solutions and one suggested hypertonic solutions within the first 24 h for fluid resuscitation. Only one formula specifically dealt with fluid resuscitation in infants.

The identified formulae led to sometimes strikingly diverse calculations of resuscitation fluid volumes. Therefore their use should be monitored closely and clinical values included. Urine output is a well established individual parameter. Use of colloid and hypertonic solutions leads to a reduced total fluid volume but is still controversially discussed.