Advances in fluid therapy and the early care of the burn patient

The resuscitation and early care of the burn patient has been placed on a more sound physiologic basis as a result of recent studies of the pathologic effects of thermal injury and the clinical application of technological advances. Whichever resuscitation formula is employed, its application should be guided by the patient's response to treatment. The surgeon must preserve vital organ function while taking advantage of compensatory mechanisms to minimize the deleterious effects of both the injury and the therapy. Resuscitation using only balanced salt solution in the first 24 hours, and reserving colloid-containing fluids for the second 24 hours, is clinically effective in the vast majority of burn patients, but should be altered in terms of volume and composition to meet the particular needs of any given burn patient. Repeated planned monitoring of cardiopulmonary function and of the peripheral circulation is mandatory to achieve maximum survival of unburned tissue and to reduce mortality. Careful fluid management, including daily assessment of fluid balance, is required from the time of admission until the burn wound has healed or been grafted.