Cartotto R, Johnson LS, Savetamal A, Greenhalgh D, Kubasiak JC, Pham TN, Rizzo JA, Sen S, Main E, et al.
Journal of burn care & research : official publication of the American Burn Association. Date of publication 2023 Dec 5;volume ():.
1. J Burn Care Res. 2023 Dec 5:irad125. doi: 10.1093/jbcr/irad125. Online ahead
of print.
American Burn Association Clinical Practice Guidelines on Burn Shock
Resuscitation.
Cartotto R(1), Johnson LS(2), Savetamal A(3), Greenhalgh D(4), Kubasiak JC(5),
Pham TN(6), Rizzo JA(7)(8), Sen S(9), Main E(10).
Author information:
(1)Department of Surgery, Ross Tilley Burn Centre, Sunnybrook Heath Sciences
Centre, University of Toronto, Canada.
(2)Department of Surgery, Walter L. Ingram Burn Center, Grady Memorial Hospital,
Emory University, Atlanta, GA, USA.
(3)Department of Surgery, Connecticut Burn Center, Bridgeport Hospital,
Bridgeport, CT, USA.
(4)Shriners Hospital for Children, Northern California, Sacramento, CA, USA.
(5)Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.
(6)Department of Surgery, University of Washington Regional Burn Center,
Harborview Medical Center, Seattle, WA, USA.
(7)Department of Trauma, Brooke Army Medical Center, Fort Sam Houston, San
Antonio, TX, USA.
(8)Uniformed Services University of Health Sciences, Bethesda, MD, USA.
(9)Department of Surgery, Division of Burn Surgery, University of California,
Davis, CA, USA.
(10)Sunnybrook Health Sciences Centre, Toronto, Canada.
This Clinical Practice Guideline (CPG) addresses the topic of acute fluid
resuscitation during the first 48 hours following a burn injury for adults with
burns ≥20% of the total body surface area (%TBSA). The listed authors formed an
investigation panel and developed clinically relevant PICO (Population,
Intervention, Comparator, Outcome) questions. A systematic literature search
returned 5978 titles related to this topic and after 3 levels of screening, 24
studies met criteria to address the PICO questions and were critically reviewed.
We recommend that clinicians consider the use of human albumin solution,
especially in patients with larger burns, to lower resuscitation volumes and
improve urine output. We recommend initiating resuscitation based on providing 2
mL/kg/% TBSA burn in order to reduce resuscitation fluid volumes. We recommend
selective monitoring of intra-abdominal and intraocular pressure during burn
shock resuscitation. We make a weak recommendation for clinicians to consider
the use of computer decision support software to guide fluid titration and lower
resuscitation fluid volumes. We do not recommend the use of transpulmonary
thermodilution-derived variables to guide burn shock resuscitation. We are
unable to make any recommendations on the use of high-dose vitamin C (ascorbic
acid), fresh frozen plasma (FFP), early continuous renal replacement therapy, or
vasopressors as adjuncts during acute burn shock resuscitation. Mortality is an
important outcome in burn shock resuscitation, but it was not formally included
as a PICO outcome because the available scientific literature is missing studies
of sufficient population size and quality to allow us to confidently make
recommendations related to the outcome of survival at this time.
© The Author(s) 2023. Published by Oxford University Press on behalf of the
American Burn Association. All rights reserved. For permissions, please e-mail:
journals.permissions@oup.com.
DOI: 10.1093/jbcr/irad125
PMID: 38051821
