The comparison of early fluid therapy in extensive flame burns between inhalation and noninhalation injuries

Over the last half century, advances in treatment have changed the principa l cause of death in burn patients from burn shock and wound sepsis to pulmo nary sepsis, of which inhalation injury has always played a key role in mor bidity and mortality. Even though Navar et al., Am. J. Surg. 1985;150:716-7 20 have noted that patients with inhalation injury had a mean fluid require ment of 5.8 ml/kg/% burn to achieve resuscitation from early burn shock, wh ile patients without inhalation injury required only a mean fluid of 4.0 ml /kg/% burn, to achieve successful resuscitation in inhalation injured patie nts with minimum but adequate fluid has always been a challenge. To further define the difference of early fluid therapy between inhalation and noninh alation in extensively burned patients, a retrospective analysis was carrie d out in the Tri-Service General Hospital. Sixty-two flame burned patients (aged from 16 to 81 years-old with a mean age of 33.2 +/- 15.1 years; with burn size ranging from 30% to 98% TBSA with a mean burn size of 60.5 +/- 22 .7%; 26 with inhalation injury; noninhalation 36) were reviewed during a 5- year period. The Parkland formula is the initial choice of fluid regimen wi th 4 ml/kg/% burn and the amount of replacement is monitored by urine outpu t and is titrated to maintain urine output between 0.5 and 1.0 ml/kg/h. The mean amounts of fluid requirements of both inhalation and noninhalation bu rned patients were 3.1 +/- 1.0 and 2.3 +/- 0.8 ml/kg/% burn respectively (p < 0.05). Our study showed less fluid requirement for both inhalation and n oninhalation injured patients in comparison with the Navar study and Parkla nd predictions in the first 24 h postburn. Furthermore, the inhalation inju red patients definitely required volumes of fluid in excess of those requir ed in noninhalation injured cases. (C) 1998 Elsevier Science Ltd for ISBI. All rights reserved.