Fluid Resuscitation After Major Burns

IN THE 1940s, hypovolemic shock in the early postburn period was the leading cause of death after severe burn injury. Today, with our current knowledge of the massive fluid shifts and vascular changes that occur, early mortality has decreased considerably. The failure rate for adequate volume restoration is less than 5%, even for deep burns involving up to 85% of the total body skin surface.¹ The problem of nonreversible shock has now been replaced by that of generalized burn edema formation, a problem clearly less lethal but one that can result in serious morbidity. Tissue ischemia due to an increase in interstitial pressure is one complication of edema.² Pulmonary insufficiency, as a result of both a decrease in chest wall compliance from tissue edema and an increase in blood volume during edema mobilization, is another potential complication. Hypovolemia can be corrected and edema at least partially controlled, however,