Critical Care of the Burn Patient: The First 48 Hours

Barbara A. Latenser, MD, FACS


Crit Care Med. 2009;37(10):2819-2826. 

In This Article


Not many topics in acute burn care are more hotly debated than fluid resuscitation and monitoring. Burn management is still not evidence based as in many areas of acute medicine.[24] However, there does seem to be agreement among burns surgeons that: 1) the Consensus formula provides for a hypovolemic resuscitation; 2) patients with inhalation injury will require more fluid than that prescribed by the Consensus formula; and 3) over-resuscitation leads to excessive burn edema, abdominal compartment syndrome, need for fasciotomies on unburned limbs, pulmonary edema, and prolongation of mechanical ventilation. Type of monitoring to use during the early resuscitation period remains controversial in part because current end points have not yet been demonstrated to reflect tissue perfusion status independently and accurately.[5,91] Vital signs and urine output in burn patients do not fulfill these criteria.[14] Defining better end points of resuscitation to avoid excessive volume administration is a high priority for future investigations.[4] Future improvements in managing burn shock will include a complex ballet that includes pharmacologic interventions, rapid surgical removal of necrotic tissue, and a dynamic range of fluid types and rates of delivery. The continuing challenge for burn clinicians and researchers is to collaborate in large multicenter studies to critically evaluate and establish resuscitation end points and therapies.[5,36]


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