Saffle JI
Journal of burn care & research : official publication of the American Burn Association. Date of publication 2007 May 1;volume 28(3):382-95.
1. J Burn Care Res. 2007 May-Jun;28(3):382-95.
The phenomenon of "fluid creep" in acute burn resuscitation.
Saffle JI(1).
Author information:
(1)Department of Surgery, 3B-306, University of Utah Health Center, 50 N. Medical
Drive, Salt Lake City, UT 84132, USA.
Comment in
J Burn Care Res. 2007 Sep-Oct;28(5):770-2.
Several reports have documented that modern burn patients receive far more
resuscitation fluid than predicted by the Parkland formula-a phenomenon termed
"fluid creep." This article reviews the incidence, consequences, and possible
etiologies of fluid creep in modern practice and uses this information to propose
some therapeutic strategies to reduce or eliminate excessive fluid resuscitation
in burn care. A literature review was performed of historical references that
form the foundation of modern fluid resuscitation, as well as reports of fluid
creep and its consequences. The original Parkland formula required a 24-hour
volume of 4 ml/kg/%TBSA lactated Ringer's solution followed by an infusion of
0.3-0.5 ml/kg/ %TBSA plasma. Modern iterations of this formula have omitted the
colloid bolus. Numerous exceptions to the formula have been noted, most
consistently patients with inhalation injuries. In contrast, recent reports
document greatly increased fluid requirements in unselected patients, which seems
to consist largely of progressive edema formation in unburned areas, increasing
after the first 8 hours post-burn. This has been linked to occurrence of the
abdominal compartment syndrome and other serious complications. Strategies to
reduce fluid creep include the avoidance of early overresuscitation, use of
colloid as a routine component of resuscitation or for "rescue," and adherence to
protocols for fluid resuscitation. Fluid creep is a significant problem in modern
burn care. Review of original investigations of burn shock, coupled with modern
reports of fluid creep, suggests several mechanisms by which this problem can be
controlled. Prospective trials of these therapies are needed to confirm their
effectiveness.
DOI: 10.1097/BCR.0B013E318053D3A1
PMID: 17438489 [Indexed for MEDLINE]
Appears in following Topics:
