Fluid resuscitation of the extensively burned patient

Several formulas have been used to estimate fluid needs for the first and second post-burn days. There are however patients who are either volume intolerant or fail to respond to these resuscitations, and for those patients the resuscitation regimen used may have to be modified. To avoid excessive volume administration, the fluid infusion rate and hourly urinary output should be titrated during the second 24 hours post-burn when cardiac output has returned to normal and plasma volume restoration has begun. Resuscitation is guided by careful and frequent monitoring of hourly urinary output, vital signs and general condition. Fluid administration is modified as indicated by the observed changes or departures from the anticipated physiologic response. Timely infusion of fluids avoiding excess of either sodium or volume load, insures maintenance of vital organ function at the least immediate or delayed physiologic cost.