Burns: Fluid Creep

The podcast reviews Dr. Jeff Saffel's article in the Journal of Burn Care and Rehab, which addresses fluid creep and acute burn resuscitation. It traces the evolution of burn resuscitation from the World War II era to the present day, highlighting the development and subsequent modifications of the Parkland formula. The discussion emphasizes that modern burn care often involves fluid volumes exceeding Parkland predictions, leading to complications like edema and abdominal compartment syndrome. The podcast explores reasons for fluid creep, including the underutilization of colloids, variations in burn center practices, and the potential pitfalls of goal-directed resuscitation using PA catheters. It advocates for a balanced approach, suggesting restricted early fluid resuscitation, judicious use of colloids, and adherence to resuscitation protocols to avoid over-resuscitation and its associated complications.

Outlines

Part 1: History, Evolution

Part 2: Complications, Clinical Factors

Part 3: Therapy, Monitoring

Part 4: Strategies, Future Outlook

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ICU Rounds

Part 1: History, Evolution

Historical Development of Burn Resuscitation and the Emergence of Fluid Creep

Fluid Creep: Questioning the Parkland Formula and Conservative Resuscitation

The Original Parkland Formula: Lactated Ringers and Plasma Administration

Baxter's Results and the Importance of Plasma in Burn Resuscitation

The NIH Conference and the Departure from the Original Parkland Formula

Part 2: Complications, Clinical Factors

Factors Contributing to Fluid Creep: Inexperienced Clinicians and Inaccurate Estimations

Variations in Practice, Burn Size, and Goal-Directed Resuscitation

Part 3: Therapy, Monitoring

Goal-Directed Therapy and the Restoration of Cardiac Function

The Microwave Society and the Prejudice Against Colloid

Part 4: Strategies, Future Outlook

Re-evaluating Colloid Use and Strategies to Avoid Fluid Creep

Resuscitation Protocols, Colloid Rescue, and Summary of Key Points

Burns: Fluid Creep

ICU Rounds

Part 1: History, Evolution

00:00Historical Development of Burn Resuscitation and the Emergence of Fluid Creep

Historical Development of Burn Resuscitation and the Emergence of Fluid Creep

01:39Fluid Creep: Questioning the Parkland Formula and Conservative Resuscitation

Fluid Creep: Questioning the Parkland Formula and Conservative Resuscitation

03:26The Original Parkland Formula: Lactated Ringers and Plasma Administration

The Original Parkland Formula: Lactated Ringers and Plasma Administration

04:58Baxter's Results and the Importance of Plasma in Burn Resuscitation

Baxter's Results and the Importance of Plasma in Burn Resuscitation

06:32The NIH Conference and the Departure from the Original Parkland Formula

The NIH Conference and the Departure from the Original Parkland Formula

Part 2: Complications, Clinical Factors

08:52Factors Contributing to Fluid Creep: Inexperienced Clinicians and Inaccurate Estimations

Factors Contributing to Fluid Creep: Inexperienced Clinicians and Inaccurate Estimations

10:43Variations in Practice, Burn Size, and Goal-Directed Resuscitation

Variations in Practice, Burn Size, and Goal-Directed Resuscitation

Part 3: Therapy, Monitoring

12:33Goal-Directed Therapy and the Restoration of Cardiac Function

Goal-Directed Therapy and the Restoration of Cardiac Function

14:46The Microwave Society and the Prejudice Against Colloid

The Microwave Society and the Prejudice Against Colloid

Part 4: Strategies, Future Outlook

16:24Re-evaluating Colloid Use and Strategies to Avoid Fluid Creep

Re-evaluating Colloid Use and Strategies to Avoid Fluid Creep

18:44Resuscitation Protocols, Colloid Rescue, and Summary of Key Points

Resuscitation Protocols, Colloid Rescue, and Summary of Key Points