A Biopsy of the Use of the Baxter Formula to Resuscitate Burns or Do We Do It Like Charlie Did It?

Engrav, Loren H.; Colescott, P. L.; Kemalyan, Nathan; Heimbach, David M.; Gibran, Nicole S.; Solem, Lynn D.; Dimick, Alan R.; Gamelli, Richard L.; Lentz, Christopher W.

doi:10.1097/00004630-200021020-00002

Cited by 137 publications

(54 citation statements)

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“…Indeed, the use of balanced crystalloid resuscitation in patients with diabetic ketoacidosis, despite the added (potassium) content [(K + ) 5.0 mmol/L], was associated with more rapid correction of base deficit when compared to 0.9% saline [49] . Recent data have also clearly shown high (chloride) solutions contribute to renal vasoconstriction, decreased glomerular filtration, greater interstitial fluid accumulation [29][30][31][32][33][34] along with increased risk of acute kidney injury (AKI) and utilization of renal replacement therapy (RRT) [35] .…”

Section: Type Of Fluid Therapymentioning

confidence: 99%

“…Failure to appreciate these phases of fluid management following resuscitation may underscore the observed phenomenon of "fluid creep", first identified in the burn literature in response to the overwhelming enthusiasm for aggressive and sustained fluid resuscitation [29,32] . These observations highlight the importance of monitoring fluid balance in critical illness, in particular after the initial phase of resuscitation, where obligatory fluid intake (i.e., medications, nutrition, blood products) may greatly exceed output (i.e., relative oliguria), leading to rapid fluid accumulation [34] .…”

Section: Quantitative Toxicitymentioning

confidence: 99%

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Controversies in fluid therapy: Type, dose and toxicity

McDermid

Raghunathan

Romanovsky

et al. 2014

WJCCM

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Fluid therapy is perhaps the most common intervention received by acutely ill hospitalized patients; however, a number of critical questions on the efficacy and safety of the type and dose remain. In this review, recent insights derived from randomized trials in terms of fluid type, dose and toxicity are discussed. We contend that the prescription of fluid therapy is context-specific and that any fluid can be harmful if administered inappropriately. When contrasting ''crystalloid vs colloid'', differences in efficacy are modest but differences in safety are significant. Differences in chloride load and strong ion difference across solutions appear to be clinically important. Phases of fluid therapy in acutely ill patients are recognized, including acute resuscitation, maintaining homeostasis, and recovery phases. Quantitative toxicity (fluid overload) is associated with adverse outcomes and can be mitigated when fluid therapy based on functional hemodynamic parameters that predict volume responsiveness and minimization of non-essential fluid. Qualitative toxicity (fluid type), in particular for iatrogenic acute kidney injury and metabolic acidosis, remain a concern for synthetic colloids and isotonic saline, respectively. Physiologically balanced crystalloids may be the ''default'' fluid for acutely ill patients and the role for colloids, in particular hydroxyethyl starch, is increasingly unclear. We contend the prescription of fluid therapy is analogous to the prescription of any drug used in critically ill patients.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Fluid therapy; Resuscitation; Critical illness; Peri-operative; Toxicity; Saline; Crystalloid; Colloid Core tip: Fluid therapy is exceedingly common in acutely ill patients; however, numerous questions on the efficacy and safety of fluid therapy in terms of the type and dose remain. Fluid therapy prescription is contextspecific and any fluid type can be harmful if administered inappropriately. When considering crystalloids versus colloids, differences in efficacy are modest but the risk of kidney toxicity and bleeding complications with hydroxyethyl starch appear more significant. The differences in chloride load across crystalloid solutions appears to have physiologic and clinically important effects, in particular for contributing to hyperchloremic metabolic acidosis, kidney injury and greater utilization of renal replacement therapy associated with 0.9% saline. Fluid therapy should be viewed as analogous to the prescription of any drug in acutely ill patients.McDermid RC, Raghunathan K, Romanovsky A, Shaw AD, Bagshaw SM. Controversies in fluid therapy: Type, dose and toxicity.

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Section: Type Of Fluid Therapymentioning

confidence: 99%

Section: Quantitative Toxicitymentioning

confidence: 99%

Controversies in fluid therapy: Type, dose and toxicity

McDermid

Raghunathan

Romanovsky

et al. 2014

WJCCM

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“…Actual fluid volumes administered exceed the calculated volume in 12 to 58% of patients. 1 Reasons for this reflect not only the severity of injury but also may result from associated injuries, age, premorbid conditions, and inhalation injury.…”

Section: Discussionmentioning

confidence: 99%

The Methamphetamine Burn Patient

Warner¹,

Connolly

Gibran³

et al. 2003

The Journal of Burn Care &Amp; Rehabilitation

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Early aggressive fluid resuscitation has significantly decreased the morbidity and mortality associated with volume losses from large burns. Although most patients are adequately resuscitated using the Parkland formula, we noted increased fluid requirements for shock resuscitation in patients involved in methamphetamine laboratory explosions. Because predominant users are young healthy individuals in their 20s and 30s, we had not anticipated burn shock resuscitation failures in this patient group. We reviewed our experience with burn patients with documented methamphetamine use to determine whether this patient group presents new dilemmas to the burn surgeon. A 2-year retrospective study of 30 patients (15 methamphetamine users, 15 controls) revealed that the methamphetamine burn patient requires two to three times the standard Parkland formula resuscitation. In this study, methamphetamine burns larger than 40% TBSA had a 100% mortality.

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“…Untersubstitution in Abhängigkeit von der verwendeten Formel nicht selten ist [16,17,19,42,55]. Untersuchungen zum Substitutionsvolumen haben gezeigt, dass 58-84% der Verletzten mehr Volumen sub stituiert wird, als von der genutzten Formel vorgegeben ("fluid creep"; [11,21]). Gründe hierfür vermutet man u. a. in der Steuerung der Volumengabe nach klinischen Gesichtspunkten (z.…”

Section: Inadäquate Volumentherapieunclassified