![]() ![]() He proposed three levels of fluid resuscitation. Gelin was the first to propose a single figure formula. They combine all of their fluid needs into a single formula. In contrast with two figure formulae, single figure formulae do not consider the maintenance needs separate from the burn resuscitation fluids. The Brooke formula uses one-fourth plasma and three-fourth crystalloid. It differs in the amount of plasma that is provided, and the crystalloid used is lactated Ringer’s. and is similar to the Evans formula in that it prescribes 2 ml/kg/%TBSA burn to be administered in the first 24 h. The Brooke formula was developed in 1953 by Reiss et al. ![]() The Evans formula utilized one-half plasma and one-half crystalloid (normal saline). This formula utilized 2 ml/kg/%TBSA burn plus 2000 ml of maintenance fluids to replace normal losses. In 1952, the Evans formula was developed. ![]() The two most well known of the “two figure formulae” are the Evans formula and the Brooke formula. The two-figure approach provides safeguards for the young, the obese, and children with large burns. This was the advent of formulas that are classified as “two figure formulae” which accounted for burn-related fluid losses separate from estimations of maintenance fluid needs. This pattern of fluid administration is replicated in most subsequent formulas. Half of this fluid is given over the first 8 h, and the second half of the fluid is administered over the next 16 h (see Table 1). Their formula for IV fluid resuscitation used equal parts of plasma and saline and prescribed 150 ml of fluid for each 1% TBSA burn plus maintenance fluids during the first 24 h following injury. Cope and Moore recognized the relationship between the amount of fluid resuscitation required and the size of the burn. In November, 1942, Oliver Cope and Francis Moore utilized this knowledge and improved upon it as they treated the victims of the Cocoanut Grove nightclub fire. The size of the burn was not a consideration in any of these formulas. The formulas that were designed for fluid resuscitation of burn-injured patients in the decade following Uphill’s work utilized plasma and based their estimates of fluid required on patient weight, and either total serum protein level or hematocrit. Unfortunately, further work investigating the fluid losses and resuscitation of burn patients was not undertaken until the 1930s when Frank Underhill analyzed the composition of the fluid in blisters of burn-injured patients and found that it was similar in character to plasma. The idea of fluid resuscitation in burn patients gained further traction when Ludwig von Buhl made the correlation between the fluid losses in burn patients and in those with cholera and advocated for the administration of saline solution to replace losses. In this review, we will discuss the history of fluid resuscitation, current resuscitation practices, and future directions of resuscitation for the pediatric burn population.įluid resuscitation as a treatment for burn injury is thought to date back to the eighteenth century when Gerard van Swieten administered fluid via enema to rehydrate burn victims. They have unique physiologic needs that must be adequately addressed to successfully care for burn-injured children. The basic principles of resuscitation are the same in adults and children however, children are not simply “little adults”. Delays in resuscitation, even as short as 30 min, due to difficulty with IV access or failure to recognize size or severity of the burn can result in increased rates of complications such as acute renal failure, increased hospital length of stay, and increased mortality. Prompt resuscitation is critical in pediatric patients due to their small circulating blood volumes. It is generally believed that burns larger than 15% total body surface area (TBSA) lead to the initiation of the systemic inflammatory response syndrome requiring IV fluid resuscitation to prevent burn shock and death, while smaller burns are able to be treated with oral rehydration alone. While many of these injuries are minor and can be treated as outpatients, approximately 5% are considered moderate to severe injuries and require hospitalization. Burn injury is a leading cause of unintentional death and injury in children until 14 years of age (as high as the third most common cause in children ages 5 to 9). ![]()
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