Fluid resuscitation burn injuries

Extensive burn injuries produce a systemic response that pulls fluid from the vascular system into the interstitial space. This is exacerbated in burns greater than 20% TBSA by a significant capillary leak into the microvasculature and generalized edema. Without proper treatment, intravascular fluid loss and hypovolemic burn shock result. This is why immediate initiation of fluid resuscitation is important. A successful fluid resuscitation will maintain intravascular volume and organ perfusion until capillary membrane integrity is restored (approximately 24 to 48 hours postinjury). 

Second- or third-degree burns greater than 10%-20% TBSA or patients with significant smoke inhalation injury will require fluid resuscitation. Peripheral IV catheters can be used, but placement of a central venous catheter is optimal. An indwelling urine catheter should be placed so that output measures can he used to monitor the status of fluid resuscitation. 

Bechir M, Puhan MA, Neff SB, Guggenheim M, Wedler V, Stover IF, Stocker R, Neff TA. Early fluid resuscitation with hyper-oncotic hydroxyethyl starch 200/0.5 (10%) in severe burn injury. Crit Care 2010 14(3) R123. 

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