Resuscitation of Severely Burned Military Casualties: Fluid Begets More Fluid.

摘要

Background: In November 2005, institution of a military-wide burn resuscitation guideline requested the documentation of the initial 24-hour resuscitation of severely burned military casualties on a burn flow sheet to provide continuity of care. The guidelines instruct the providers to calculate predicted 24-hour fluid requirements and initial fluid rate based on the American Burn Association Consensus recommendation of 2 (modified Brooke) mL kg 1 % total body surface area (TBSA) 1 to 4 (Parkland) mL kg 1 %TBSA 1 burn. The objective of this study was to evaluate the relationship between the estimated fluid volumes calculated, either by the Modified Brooke or the Parkland formulas, and actual volumes received. Methods: From November 2005 to December 2008, 105 patients were globally evacuated with greater than 20% TBSA burns, of whom 73 had burn flow sheets initiated. Of these, 58 had completed burn flow sheets. Total fluids administered in the first 24-hour period for each patient were recorded. Chart reviews were performed to extract demographic and clinical outcomes data. Results: Of the 58, the modified Brooke formula was used in 31 patients (modified Brooke group) to estimate 24-hour fluid requirements and the Parkland formula was used in 21 (Parkland group).