Coda Change Burns Fluid Resuscitation with Claire Seiffert
Jul 8, 2021
Claire Seiffert, an intensivist at North Shore Hospital in Sydney, shares her expertise on burns fluid resuscitation. She explains the critical first 24 hours post-burn and the delicate balance of fluid delivery to prevent complications. Claire discusses fluid overload risks, optimal urine output targets, and the modified Parkland formula as a starting point. She also highlights specific patient factors affecting fluid needs and practical ICU actions that go beyond just fluids, emphasizing the importance of comprehensive burn care for better outcomes.
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Burn Shock Is A Mixed Physiology
- Burn shock is a mixed state with distributive, hypovolaemic and cardiogenic components peaking around 8–12 hours and improving by 24 hours.
- Recognising the three components explains why resuscitation targets and therapies must balance fluids, vasopressors and cardiac support.
Use Perfusion Targets Not Formula Alone
- Aim to restore tissue perfusion while avoiding fluid overload using MAPs around 60 mmHg and urine 0.5–1 mL/kg/hr averaged over 2 hours in adults.
- Allow modest hyperlactatemia and trend values rather than chasing normal lactates immediately.
Estimating Burn Size Often Requires Reassessment
- Accurate burn size and depth assessment is hard and often requires repeat trips to theatre and debridement for clarity.
- At referral hospitals use the rule of nines for speed, while specialist centres may use the Lund–Browder chart for precision.