Burns formulas and fluid resuscitation

In most cases either the modified Brook formula or the Parkland formula was used for burned military casualties in Iraq and Afghanistan over the three years covered in this study.
The modified Brooke formula is 2mls x body surface areas burned (BSAB) x weight.
The Parkland formula is 4mls x body surface areas burned (BSAB) x weight.
Both formulas estimate the first 24 hour fluid requirements from the time of the burn, with half the amount given in the first 8 hours.
In this study which compared outcomes between the Brooks and Parkland groups, there were no differences in clinical outcomes. In both groups many patients were overresuscitated in terms of urine output goals. The authors’ main conclusion is that burns resuscitation can be successfully accomplished with lower initial fluid volumes. Take home message: individualise fluid resuscitation to patient’s clinical response, and avoid the ‘fluid creep’ of unphysiologic resuscitation management.
Resuscitation of severely burned military casualties: fluid begets more fluid
J Trauma. 2009 Aug;67(2):231-7

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