title: Increased fluid resuscitation can lead to adverse outcomes in major-burn injured patients, but low mortality is achievable.
abstract: BACKGROUND
  Excessive fluid resuscitation of large burn injuries has been associated with adverse outcomes. We reviewed our experience in patients with major-burn injury to assess the relationship between fluid, clinical outcome and cause of variance from expected resuscitation volumes as defined by the Parkland formula.
  
  
  METHODS
  Eighty patients with new burns > or =15% total body surface area (TBSA) admitted to the intensive care unit within 48 h of injury were included.
  
  
  RESULTS
  Mean fluid volume was 6.0+/-2.3 mL/kg/% TBSA at 24h. Bolus fluids for hypotension and oliguria explained 39% of excess variance from Parkland estimates and inaccurate burn size and weight assessment explained 9% of variance. Higher fluid volume was associated with pneumonia (adjusted odds ratio [AOR]=2.0; 95% confidence interval [CI] 1.2-3.4) and extremity compartment syndrome (AOR=7.9; 95% CI 2.4-26). Colloid use during the first 24h reduced the risk of extremity compartment syndrome (AOR=0.06; 95% CI 0.007-0.49) and renal failure (AOR=0.11; 95% CI 0.014-0.82). In-hospital mortality was low (10%) and not associated with >125% Parkland resuscitation (P=0.39).
  
  
  CONCLUSIONS
  Although fluid resuscitation in excess of the Parkland formula was associated with several adverse events, mortality was low. A multi-centre trial is needed to more specifically define the indications and volumes needed for burns fluid resuscitation and revise traditional formulae emphasising patient outcome. Improved training in burn size assessment is needed.
authors.affiliation: Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia. Joel_Dulhunty@health.qld.gov.au
authors.forename: Joel M
authors.initials: JM
authors.lastname: Dulhunty
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Boots
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rudd
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Muller
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
mesh_terms: D000328:Adult; D000465:Algorithms; D001830:Body Surface Area; D002056:Burns / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D003102:Colloids / Q000008:administration & dosage* / Q000009:adverse effects; D003161:Compartment Syndromes / Q000453:epidemiology / Q000209:etiology; D003422:Critical Care / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003102:Colloids; D007552:Isotonic Solutions