MPS  Vol.3 No.4 , October 2013
The Combination of Parkland Formula, Using Normal Saline, with Muir & Barclay Formula for Fluid Resuscitation in the Initial Burn Shock Period

Objectives: Evaluation of the effects of withholding plasma during the initial part of the burn shock period (the shock period in the study is estimated as the first 36 hours following the burns) when it will be lost into the interstitial tissues through the permeable capillaries. During that time crystalloids are administered. Another objective is to evaluate the effect of administering normal saline as the crystalloid resuscitation fluid during the initial part of the shock period. Design: A Retrospective 4 years study compares the use of normal saline as the resuscitative intravenous fluid during the first 12 hours post burns followed by intravenous 5% Purified Plasma Protein Fraction (PPPF) during the rest of the shock period i.e. the remaining 24 hours, with the use of the PPPF throughout the burns shock period according to Muir and Barclay formula. Setting: The Plastic Surgery Department and the Department of Laboratory, Directorate General of Khoula Tertiary Hospital, Muscat, Sultanate of Oman. Patients and Methods: The study included 2 groups of patients; Group A: Patients who received 5% Plasma (Human PPPF) throughout the shock period and Group B: Patients who received crystalloids in the form of normal saline during the first 12 hours post burn followed by plasma for the next 24 hours. Monitoring of the patients in both groups was done by using clinical signs of pulse, blood pressure, temperature and urine output and by using laboratory investigations in the form of the haematocrit value, sodium, potassium, chloride, total proteins and albumin levels in the blood at the time of admission and at the end of the shock period. Results: 140 patients were included in the study; 64 in Group A and 76 in Group B. There was no mortality and the vital signs were maintained during the shock period in both groups. The mean values of urine output were nearer to the normal level in Group B compared to Group A. The same was observed regarding the Haematocrit value. In both groups the mean values showed no hypoproteinaemia or hypoalbuminaemia at the end of the shock period. There was no hypernatraemia in spite of giving 150 mmol/L of Na during the initial 12 hours post burns in Group B. The mean values of potassium and chloride levels were normal in both groups at the end of the shock period. Conclusion: Giving plasma during the first 12 hours of the burn shock period when the capillary leakage is maximum has no significant benefit. The plasma usage can be reduced by 50% compared to the use of the Muir and Barclay Formula from the beginning of the shock period with reduction of the costs and the possibility of transmission of undetected pathogens by nearly the same value if crystalloids are given during the first 12 hours of burns shock period. The use of isotonic normal saline during the first 12 hours appears more appropriate as it maintains adequate sodium balance to correct the hyponatraemia and at the same time prevents elevation of the serum potassium during the period when potassium is released from the cells. In addition, it does not have a significant reduction on the level of the serum proteins.

Cite this paper
M. Habib, S. Al-Busaidi, G. Latif, A. Mehdi and C. Thomas, "The Combination of Parkland Formula, Using Normal Saline, with Muir & Barclay Formula for Fluid Resuscitation in the Initial Burn Shock Period," Modern Plastic Surgery, Vol. 3 No. 4, 2013, pp. 142-149. doi: 10.4236/mps.2013.34029.
[1]   E. Evans, O. Purnell, P. Robinett, A. Batchelor and M. Martin, “Fluid and Electrolyte Requirements in Severe Burns,” Annals of Surgery, Vol. 135, No. 6, 1952, p. 804. 00000658-195206000-00006

[2]   C. A. Moyer, H. W. Margraf and W. W. Monafo, “Burn Shock and Extravascular Sodium Deficiency: Treatment with Ringer’s Solution with Lactate,” Archives of Surgery, Vol. 90, 1965, pp. 799-811.

[3]   G. Arturson, “Pathophysiological Aspects of the Burn Syndrome with Special Reference to Liver Injury and Alterations of Capillary Permeability,” Acta Chirurgica Scandinavica. Supplementum, Vol. 274, 1961, pp. 1-135.

[4]   W. W. Monafo, “The Treatment of Burn Shock by the Intravenous and Oral Administration of Hypertonic Lactated Saline Solution,” Journal of Trauma, Vol. 10, No. 7, 1970, pp. 575-586.

[5]   G. T. Shires, C. J. Carrico, C. R. Baxter, A. H. Giesecke and M. T. Jenkins, “Principles in Treatment of Severely Injured Patients,” Advances in Surgery, Vol. 4, 1970, pp. 255-324.

[6]   C. R. Baxter and T. Shires, “Physiological Response to Crystalloid Resuscitation of Severe Burns,” Annals of the New York Academy of Sciences, Vol. 150, No. 3, 1968, pp. 874-894.

[7]   S. Tricklebank, “Modern Trends in Fluid Therapy for Burns,” Burns, Vol. 35, No. 6, 2009, pp. 757-767.

[8]   Guyton and Hall, “Textbook of Medical Physiology,” 9th Edition, 1996, pp. 187-193.

[9]   T. Lund, H. Onarheim and R. K. Reed, “Pathogenisis of Edema Formation in Burn Injuries,” World Journal of Surgery, Vol. 16, No. 1, 1992, pp. 2-9.

[10]   C. Holm, “Resuscitation in Shock Associated with Burns. Tradition or Evidence-Based Medicine?” Resuscitation, Vol. 44, No. 3, 2000, pp. 157-164.

[11]   A. R. Webb, “Crystalloid or Colloid for Resuscitation. Are We Any the Wiser?” Critical Care, Vol. 3, No. 3, 1999, pp. 25-28.

[12]   L. Fodor, A. Fodor, Y. Ramon, O. Shoshani, Y. Rissin and Y. Ullmann, “Controversies in Fluid Resuscitation for Burn Management: Literature Review and Our Experience,” Injury, Vol. 37, No. 5, 2006, pp. 374-379.

[13]   M. J. Davies, “Crystalloid or Colloid: Does It Matter?” Journal of Clinical Anesthesia, Vol. 1, No. 6, 1989, pp. 464-471.

[14]   M. I. Griffel and B. S. Kaufman, “Pharmacology of Colloids and Crystalloids,” Critical Care Clinics, Vol. 8, No. 2, 1992, pp. 235-253.

[15]   A. Aharoni, D. Abramovici, M. Weinberger, R. Moscona and B. Hirshowitz, “Burn Resuscitation with a Low-Volume Plasma Regimen—Analysis of Mortality,” Baillière’s Clinical Anaesthesiology, Vol. 11, 1997, pp. 369-384.

[16]   R. S. Bisonni, D. R. Holtgrave, F. Lawler and D. S. Marley, “Colloids versus Crystalloids in Fluid Resuscitation: An Analysis of Randomized Controlled Trials,” Journal of Family Practice, Vol. 32, No. 4, 1991, pp. 387-390.

[17]   D. C. Gore, J. M. Dalton and T. W. Gehr, “Colloid Infusions Reduce Glomerular Filtration in Resuscitated Burn Victims,” Journal of Trauma, Vol. 40, No. 3, 1996, pp. 356-360.

[18]   G. Schierhout and I. Roberts, “Fluid Resuscitation with Colloid or Crystalloid Solutions in Critically Ill Patients: A Systematic Review of Randomized Trials,” BMJ, Vol. 316, No. 28, 1998, pp. 961-964.

[19]   I. Roberts, “Cochrane Injuries Group Albumin Reviewers. Human Albumin Administration in Critically Ill Patients: Systematic Review of Randomised Controlled Trials,” BMJ, Vol. 317, No. 7153, 1998, pp. 235-340.

[20]   G. V. Sudhakar, and P. Lakshmi, “Role of HES 130/ 0.4 in Resuscitation of Patients with Major Burn Injury,” Transfusion Alternatives in Transfusion Medicine, Vol. 10, No. 2, 2008, pp. 43-50.

[21]   R. Cole, “The UK Albumin Debate,” Burns, Vol. 25, No. 7, 1999, p. 565.

[22]   A. J. Cocks, A. O’Connell and H. Martin, “Crystalloids, Colloids and the Kids: A Review of Paediatric Burns in Intensive Care,” Burns, Vol. 24, No. 8, 1998, pp. 717-724.

[23]   S. Tricklebank, “Modern Trends in Fluid Therapy for Burns,” Burns, Vol. 35, No. 6, 2009, pp. 757-767.

[24]   M. Haberal, E. S. Abali and H. Karakayali, “Fluid Management in Major Burn Injuries,” Indian Journal of Plastic Surgery, Vol. 43, Suppl. 1, 2010, pp. 29-36.

[25]   G. D. Warden, “Burn Shock Resuscitation,” World Journal of Surgery, Vol. 16, No. 1, 1992, pp. 16-23.

[26]   C. Csontos, V. Foldi, T. Fischer and L. Bogar, “Factors Affecting Fluid Requirement on the First Day after Severe Burn Trauma,” ANZ Journal of Surgery, Vol. 77, No. 9, 2007, pp. 745-748.

[27]   J. R. Saffle, “The Phenomenon of ‘Fluid Creep’ in Acute Burn Resuscitation,” Journal of Burn Care & Research, Vol. 28, No. 3, 2007, pp. 382-395.

[28]   K. K. Chung, L. H. Blackbourne, S. E. Wolf, et al., “Evolution of Burn Resuscitation in Operation Iraqi Freedom,” Journal of Burn Care & Research, Vol. 27, No. 5, 2006, pp. 606-611.

[29]   C. J. Yowler and R. B. Fratianne, “Current Status of Burn Resuscitation,” Clinics in Plastic Surgery, Vol. 27, No. 1, 2000, pp. 1-10.

[30]   A. D. Mansfield, “Resuscitation and Monitoring,” Resuscitation, Vol. 44, No. 3, 2000, pp. 157-164.

[31]   D. Mahler, A. Baruchin, D. Hauben, A. R. Moscona, B. Hirshowitz, H. Y. Kaplan, I. Peled, M. R. Wexler, E. Vure and J. Shulman, “Recent Concepts Regarding the Resuscitation of the Burned Patient,” Burns, Vol. 9, No. 1, 1982, pp. 30-37.

[32]   J. M. Dulhunty, R. J. Boots, M. J. Rudd, M. J. Muller and J. Lipman, “Increased Fluid Resuscitation Can Lead to Adverse Outcomes in Major-Burn Injured Patients, but Low Mortality Is Achievable,” Burns, Vol. 34, No. 8, 2008, pp. 1090-1097.

[33]   R. Touquet, J. Fothergill and M. W. Platt, “Resuscitation,” In: R. M. Kirk, A. O. Mansfield and J. P. S. Cochrane, Eds., Clinical Surgery in General, 3rd Edition, 1999, pp. 3-18.

[34]   W. F. Ganong, “Review of Medical Physiology; Section IV Endocrinology, Metabolism and Reproductive Function; 17 Energy Balance,” Metabolism and Nutrition, 1995, pp. 255-289.

[35]   L. P. Kamolz, H. Andel, W. Schramm, G. Meissl, D. N. Herndon and M. Frey, “Lactate: Early Predictor of Morbidity and Mortality in Patients with Severe Burns,” Burns, Vol. 31, No. 8, 2005, pp. 986-990.

[36]   J. K. Rose and D. N. Herndon, “Advances in the Treatment of Burn Patients,” Burns, Vol. 23, Suppl. 1, 1997, pp. S19-S26.

[37]   G. D. Warden, “Burn Shock Resuscitation,” World Journal of Surgery, Vol. 16, No. 1, 1992, pp. 16-23.