Higher Initial Formula for Resuscitation After Severe Burn Injury Means Higher 24-Hour Volumes

Area of Science:

• Trauma Surgery
• Burn Care
• Resuscitation Medicine

Background:

• Standard burn resuscitation uses formulas based on patient weight and total body surface area (TBSA) burned.
• The impact of initial fluid infusion rates on resuscitation volumes and patient outcomes requires further investigation.

Purpose of the Study:

• To evaluate the effect of different initial fluid resuscitation rates on 24-hour fluid volumes and patient outcomes.
• To compare the efficacy and safety of various fluid resuscitation formulas in burn patients.

Main Methods:

• Analysis of the Burn Navigator (BN) database, including 296 patients with ≥20% TBSA and >40 kg body weight.
• Comparison of four resuscitation arms: 2 ml/kg/TBSA, 3 ml/kg/TBSA, 4 ml/kg/TBSA, and the Rule of Ten.
• Assessment of total 24-hour fluid volumes and resuscitation-related outcomes, including shock incidence and 7-day mortality.

Main Results:

• Higher initial fluid rates (4 ml/kg/TBSA) led to significantly greater 24-hour fluid volumes (5.2 ± 2.2 ml/kg/TBSA) compared to lower rates (2 ml/kg/TBSA, 3.9 ± 1.4 ml/kg/TBSA).
• The lowest initial rate (2 ml/kg/TBSA) showed a 12% incidence of shock, lower than the Rule of Ten and 3 ml/kg/TBSA groups.
• No significant differences in 7-day mortality were observed across all study arms.

Conclusions:

• Higher initial fluid resuscitation rates increase total 24-hour fluid administration.
• An initial fluid rate of 2 ml/kg/TBSA is a safe resuscitation strategy for burn patients, not associated with increased mortality or complications.
• The choice of initial fluid rate impacts resuscitation volume but not necessarily patient mortality or complications.