True statement about burn resuscitation ?
Ans is 'c' i.e. Half of the calculated fluid given in initial 8 hrs Proper fluid management is critical to survival in a burn patient. The hypovolemic shock in burn patient is special in the sense that the total body water remains unchanged in a burn patient. The thermal injury leads to a massive fluid shift from intravascular compament to the extravascular compament (interstitial + intracellular) leading to edema formation (in both burned pas and non burned pas of body) This fluid shift is maximum in the first 24 hrs. Fluid resuscitation begins with an isotonic crystalloid solution - Ringer's lactate solution (RL) is the preferred solution (Normal saline should be avoided as the volumes required for resuscitation may lead to hyperchloremic metabolic acidosis). The concept behind the continuous fluid resuscitation is that the burn (and/or inhalation injury) drives an inflammatory response that leads to capillary leak; as the plasma leaks into the extravascular space, crystalloid administration would maintain the intravascular volume. - The quantity of crystalloid needed for adequate resuscitation is determined by Parkland formula i.e. 4 mL/kg per % of TBSA burn. (Note that a number of formulas exist for calculating fluid needs during burn resuscitation, suggesting that no one formula benefits all patients. Parkland is one of the most commonly used formulas) - half of the calculated fluid is given in first 8 hrs and half in next 16 hrs. Colloids are given in the next 24 hrs. The reason behind it being the observation that in the initial period, the vascular permeability is so large that even larger protein molecules leak from the capillaries. (But some workers, prefer to use colloids after 8 to 12 hrs, while there are some who use it from the very beginning) A number of parameters are widely used to assess burn resuscitation, but the most common remain the simple outcomes of blood pressure and urine output. As in any critically ill patient, the target MAP is 60 mmHg to ensure optimal end-organ perfusion. Goals for urine output should be 30 mL/h in adults and 1 to 1.5 mL/kg per hour in pediatric patients. * There is no use of diuretics in burn resuscitation. Children under 20 kg have the additional requirement that they do not have sufficient glycogen stores to maintain an adequate glucose level in response to the inflammatory response. Specific pediatric formulas have been described, but the simplest approach is to add maintenance IV fluid with glucose supplementation in addition to the calculated resuscitation fluid with lactated Ringer's.
Colloid preferred in initial 24 hrs
Colloid preferred if burnt area is > 15 % of total BSA
Half of the calculated fluid given in initial 8 hrs.
Urine output should be maintained at 50-60 mL/hr.