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JBUR-2787; No of Pages 11
burns xxx (2008) xxx–xxx

available at www.sciencedirect.com

journal homepage: www.elsevier.com/locate/burns

Review

Burn resuscitation
Ricardo Alvarado a,b, Kevin K. Chung b, Leopoldo C. Cancio a,b, Steven E. Wolf a,b,*
a b

Department of Surgery, University of Texas Health Science Center-San Antonio, United States Burn Centre, United States ArmyInstitute of Surgical Research, United States

article info
Article history: Accepted 6 March 2008 Keywords: Burn resuscitation Burns Burn resuscitation evolution Future consideration in burn resuscitation

abstract
Current guidelines outlining the resuscitation of severely burned patients, in the United States, were developed over 30 years ago. Unfortunately, clinical burn resuscitation has notadvanced significantly since that time despite ongoing research efforts. Many formulas exist and have been developed with the intention of providing appropriate, more precise fluid resuscitation with decreased morbidity as compared to the current standards, such as the Parkland and modified Brooke formulas. The aim of this review was to outline the evolution of burn resuscitation, while closelyanalyzing current worldwide guidelines, adjuncts to resuscitation, as well as addressing future goals. # 2008 Elsevier Ltd and ISBI. All rights reserved.

Contents
1. 2. 3. 4. 5. 6. 7. 8. 9. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Parkland formula . . . . . . . . . . . . . . . . . . . . . Themodified Brooke formula . . . . . . . . . . . . . . . Muir–Barclay formula . . . . . . . . . . . . . . . . . . . . . Other considerations for effective resuscitation . Current effectiveness of accepted guidelines . . . Future considerations . . . . . . . . . . . . . . . . . . . . . Summation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000 000 000 000 000 000 000 000 000 000

1.

Introduction

Resuscitation after severe burn, specifically in the first24 h after injury, has been and remains a taxing assignment for all burn care providers, regardless of level of training. Accepted guidelines (Parkland and modified Brooke formulas) provide a foundation for focused resuscitation boundaries, and remain

the mainstay of what is taught about initial resuscitation around the world, from first responders to intensivists and trauma surgeons. The largedifference in recommended total fluid between these accepted formulas of resuscitation, exemplifies the ongoing controversies that exist in applying appropriate therapy [1–3]. Many studies exist that examine alterations or adjustments in resuscitation protocols that may

* Corresponding author at: US Army Institute of Surgical Research, 3400 Rawley E Chambers, Building 3611, Fort Sam Houston, TX...
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