DOI: 10.1097/CCM.0b013e3181cd0f87
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Issn Print: 0090-3493
Publication Date: 2010/04/01
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Excerpt
First, Dr. Latenser states that the Parkland formula has been renamed the “Consensus formula.” This is incorrect. It was first used by the authors of the Advanced Burn Life Support course, in which fluid requirements of burn patients during the first 24 hrs after burn were estimated as 2 to 4 mL/kg per percentage total body surface area burn (2). This represents a compromise between physicians who advocated for the Parkland formula (which estimates 4 mL/kg per percentage burn) and those who advocated for the modified Brooke formula (which estimates 2 mL/kg per percentage burn). Although the Parkland formula is most commonly used in US burn centers, there is no consensus regarding which of the two formulas is superior (3). No prospective, randomized, controlled trial has ever been performed comparing the Parkland formula and the modified Brooke formula. Our group recently performed a retrospective analysis of patients with major thermal injuries from the current combat operations in Iraq and Afghanistan who were resuscitated by either the Parkland formula or the modified Brooke formula (4). Both Parkland formula and modified Brooke formula patients received more fluid than estimated by the formulas. However, the Parkland formula patients received substantially more than the modified Brooke formula patients. Regardless of which formula is used to initiate fluid resuscitation, however, it is more important to recognize the importance of careful fluid titration in the ensuing hours based on a compilation of various end points to successfully resuscitate the patient at the lowest physiologic cost.
Second, Dr. Latenser suggests that colloids do not play any role during the resuscitation of severe burns. Yet, Dr. Saffle, in his recent review, proposed that a strategy that incorporates colloid on select patients may reduce the consequences of “fluid creep” (5). Furthermore, the American Burn Association's practice guidelines for burn shock resuscitation gave it a grade A recommendation based on available data (2).
Clearly, much controversy exists when dealing with burn resuscitation. However, this “concise definitive review” is not quite definitive when it comes to these two issues.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or Department of Defense. The authors have not disclosed any potential conflicts of interest.
