TITLE:
The Combination of Parkland Formula, Using Normal Saline, with Muir & Barclay Formula for Fluid Resuscitation in the Initial Burn Shock Period
AUTHORS:
Medhat Emil Habib, Said Al-Busaidi, Gihan Adly Latif, Ali Saleem Mehdi, C. Thomas
KEYWORDS:
Normal Saline; Intravenous Resuscitation; Shock Period; Burn
JOURNAL NAME:
Modern Plastic Surgery,
Vol.3 No.4,
October
25,
2013
ABSTRACT: 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.