title: Hemodynamic changes during resuscitation after burns using the Parkland formula.
abstract: BACKGROUND
  The Parkland formula (2-4 mL/kg/burned area of total body surface area %) with urine output and mean arterial pressure (MAP) as endpoints for the fluid resuscitation in burns is recommended all over the world. There has recently been a discussion on whether central circulatory endpoints should be used instead, and also whether volumes of fluid should be larger. Despite this, there are few central hemodynamic data available in the literature about the results when the formula is used correctly.
  
  
  METHODS
  Ten burned patients, admitted to our unit early, and with a burned area of >20% of total body surface area were investigated at 12, 24, and 36 hours after injury. Using transesophageal echocardiography, pulmonary artery catheterization, and transpulmonary thermodilution to monitor them, we evaluated the cardiovascular coupling when urinary output and MAP were used as endpoints.
  
  
  RESULTS
  Oxygen transport variables, heart rate, MAP, and left ventricular fractional area, did not change significantly during fluid resuscitation. Left ventricular end-systolic and end-diastolic area and global end-diastolic volume index increased from subnormal values at 12 hours to normal ranges at 24 hours after the burn. Extravascular lung water: intrathoracal blood volume ratio was increased 12 hours after the burn.
  
  
  CONCLUSIONS
  Preload variables, global systolic function, and oxygen transport recorded simultaneously by three separate methods showed no need to increase the total fluid volume within 36 hours of a major burn. Early (12 hours) signs of central circulatory hypovolemia, however, support more rapid infusion of fluid at the beginning of treatment.
authors.affiliation: Department of Intensive Care, Heart Centre, Linköping University Hospital, Linköping, Sweden. zoltan.bak@lio.se
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Bak
authors.forename: Folke
authors.initials: F
authors.lastname: Sjöberg
authors.forename: Olle
authors.initials: O
authors.lastname: Eriksson
authors.forename: Ingrid
authors.initials: I
authors.lastname: Steinvall
authors.forename: Birgitta
authors.initials: B
authors.lastname: Janerot-Sjoberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001830:Body Surface Area; D002056:Burns / Q000503:physiopathology* / Q000628:therapy*; D002407:Catheterization, Swan-Ganz; D017548:Echocardiography, Transesophageal; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D012151:Resuscitation / Q000379:methods*; D013815:Thermodilution