The technique of fluid resuscitation for patients with severe thermal injuries: Strategies for maintaining organ perfusion while avoiding fluid overload

Patients with severe thermal injury require resuscitation to prevent hypovolemic shock. During the first 24 hours, lactated Ringer's solution should be given. To avoid overload, use the modified Brooke formula to estimate total fluid requirements. Volume should be replaced more rapidly during the first 8 hours, when third-space losses are greatest. During the second 24 hours, lactated Ringer's solution should be stopped, and albumin (diluted to physiologic concentration in normal saline) given to replenish the persistent plasma deficit. Urinary output is the most useful indicator of adequate resuscitation. Fluid needs may be greater for patients with concomitant inhalation, mechanical, or electric injury and for those in whom resuscitation is delayed.