Effect of inhalation injury on fluid resuscitation requirements after thermal injury

The presence of inhalation injury has been reported to increase fluid requirements for resuscitation from burn shock after thermal injury. To evaluate the effect of inhalation injury on the magnitude of burn-induced shock, the characteristics of resuscitation of 171 patients with burns covering at least 25 percent of the total body surface area were reviewed. When inhalation injury was suspected, confirmation by xenon-133 scanning, bronchoscopy, or both was obtained. Initial fluid resuscitation was calculated according to the Parkland formula, and titration was initiated to maintain a urine output of 30 to 50 ml/hour. Fifty-one patients had inhalation injuries. Patients with inhalation injuries had a mean fluid requirement of 5.76 ml/kg per percentage of total body surface area burned and a mean sodium requirement of 0.94 mEq/kg per percentage of total body surface area burned to achieve successful resuscitation, compared with a fluid requirement of 3.98 ml/kg per percentage of total body surface area burned and a sodium requirement of 0.68 mEq/kg per percentage of total body surface area burned for the group without inhalation injury (p less than 0.05). These data confirm and quantitate that inhalation injury accompanying thermal trauma increases the magnitude of total body injury and requires increased volumes of fluid and sodium to achieve resuscitation from early burn shock.