Burn Resuscitation

One of the great advances in burn care, developing a strategy for treating burn shock resuscitation, occurred in the 1960s and 1970s. Before this period, most people with extensive burns (>30% TBSA) would simply die within hours or, if they survived, would suffer from renal failure. Currently, burn shock resuscitation has become an afterthought that is relegated to residents and nursing staff. Calculations are performed based on protocols, and it is known that fluid rate titration should be based on urine output. Recently, however, concerns have arisen that suggest that over-resuscitation has become common. “Fluid creep” has become the term to describe a trend in giving patients too much fluid.1,–4 The issue of “fluid creep” seems to be substantiated by increased numbers of publications describing complications such as compartment syndromes, especially abdominal compartment syndrome.5,–8 These realizations suggest that there still is a long way to go in understanding the mechanisms of burn shock. The purpose of this review will be to summarize the presentation, discussions, and conclusions of burn resuscitation at the recent “State of the Science Meeting,” which took place in Washington, DC, October 26, 2006.