title: A biopsy of the use of the Baxter formula to resuscitate burns or do we do it like Charlie did it?
abstract: The Baxter formula is commonly used to calculate fluid requirements. Baxter reported that 12% of patients would require more than 4.3 mL/kg per percentage of total body surface area (%TBSA). We anecdotally observed that we frequently exceeded the predictions of the formula, and we wondered if this was unique to our practice. We studied our last 11 burn-related resuscitations and collected fluid resuscitation data from US burn centers. Twenty-eight centers were queried, and 6 centers shared data. We were therefore able to study the resuscitation data of 50 adult patients. For 29 patients (58%), 4.3 mL/kg/%TBSA was exceeded compared with the 12% reported by Baxter. These findings suggest that in actual practice, fluid volumes administered are larger than the Baxter formula predicts. This survey does not explain why. Possible reasons for the larger fluid volumes are as follows: (1) the sample is not representative; (2) the formula is used improperly; (3) burns have changed and require more fluids; (4) burn care has changed.
authors.affiliation: Division of Plastic Surgery, University of Washington Burn Center at Harborview, Seattle 98104, USA.
authors.forename: L H
authors.initials: LH
authors.lastname: Engrav
authors.forename: P L
authors.initials: PL
authors.lastname: Colescott
authors.forename: N
authors.initials: N
authors.lastname: Kemalyan
authors.forename: D M
authors.initials: DM
authors.lastname: Heimbach
authors.forename: N S
authors.initials: NS
authors.lastname: Gibran
authors.forename: L D
authors.initials: LD
authors.lastname: Solem
authors.forename: A R
authors.initials: AR
authors.lastname: Dimick
authors.forename: R L
authors.initials: RL
authors.lastname: Gamelli
authors.forename: C W
authors.initials: CW
authors.lastname: Lentz
mesh_terms: D000328:Adult; D002053:Burn Units / Q000706:statistics & numerical data*; D002056:Burns / Q000401:mortality / Q000628:therapy*; D003625:Data Collection; D019937:Diagnostic Techniques and Procedures; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012151:Resuscitation / Q000379:methods*; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014481:United States; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000628:therapy*