Fluid Resuscitation Strategies in Burn Care

Severe burns precipitate rapid fluid losses through disrupted skin barriers, systemic inflammation and heightened capillary permeability. Prompt replacement is essential to maintain circulating volume, preserve organ perfusion and prevent burn shock. Traditional approaches rely on weight- and surface-area-based formulas, notably the Parkland-Baxter regimen, which prescribes crystalloid volumes in the first 24 hours after injury. However, fixed regimens risk both under- and over-resuscitation. Under-resuscitation may lead to acute kidney injury and multi-organ failure, whereas “fluid creep” can cause pulmonary oedema, abdominal compartment syndrome and prolonged hospital stay. Contemporary strategies embrace dynamic assessment of perfusion and volume status, integrating urine output, mean arterial pressure and emerging haemodynamic tools such as transpulmonary thermodilution or bedside ultrasound. Adjunctive measures—ranging from judicious colloid use to vasoactive support and antioxidant therapies—are under investigation to optimise end-organ protection. Accumulating evidence also highlights the role of enteral fluid delivery in austere or mass-casualty settings. Across diverse health-care systems, the trend is toward individualised, goal-directed resuscitation that balances global fluid requirements against patient-specific physiology, comorbidities and burn characteristics.

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Fluid Resuscitation Strategies in Burn Care publication trend

The graph below shows the total number of articles in fluid resuscitation strategies in burn care across all publications each year (not limited to Nature Index journals).

Technical terms

Total body surface area (TBSA): percentage of the patient’s skin involved by burn injury, used to estimate fluid requirements.

Parkland-Baxter formula: a guideline for initial crystalloid infusion volume over 24 hours, calculated as 4 mL × body weight (kg) × TBSA (%).

Crystalloids and colloids: intravenous fluids; crystalloids are electrolyte solutions that distribute broadly, colloids contain larger molecules and remain in the vascular compartment longer.

Goal-directed fluid therapy (GDFT): approach that adjusts fluid and drug administration to achieve predefined physiological markers.

Transpulmonary thermodilution: invasive monitoring that quantifies cardiac output and blood volume indices via temperature changes in arterial blood after cold bolus injection.

References

1. A protocol for resuscitation of severe burn patients guided by transpulmonary thermodilution and lactate levels: a 3-year prospective cohort study. Critical Care (2013).
2. Enteral resuscitation with oral rehydration solution to reduce acute kidney injury in burn victims: Evidence from a porcine model. PLOS ONE (2018).
3. Management of severe thermal burns in the acute phase in adults and children. Anaesthesia Critical Care & Pain Medicine (2020).
4. A History of Fluid Management—From “One Size Fits All” to an Individualized Fluid Therapy in Burn Resuscitation. Medicina (2021).