Fluid management in major burns

Abstract

Advancements in the medical field have brought significant changes in burns management over the last few decades. The shock in patients with burns reflects a combination of hypovolemic, cardiogenic, and distributive shock and results in the rapid sequestration of intravascular volume into the second and third spaces, leading to intravascular depletion and large fluid shift resulting in cellular oedema. The ideal fluid for burns resuscitation is debatable, though colloids have recently seen a shift back to being used in conjunction with crystalloids, especially in later phase of resuscitation. Early and rapid resuscitation of patient with burns is a priority, as shock sets in rapidly. This chapter notes that fluid management in this subset of patients is based on resuscitation formulae and concepts elucidated decades ago; with no clear consensus on the ideal resuscitation fluid, colloids usage remains mired in controversy, and resuscitation targets and ideal monitoring tools are still poorly defined.