Colloid Administration Normalizes Resuscitation Ratio and Ameliorates “Fluid Creep” Amanda Lawrence, BSN, CC, RN, Iris Faraklas, BSN, CC, RN, Holly Watkins, RN, Ashlee Allen, RN, BSN, Amalia Cochran, MD, FACS, Stephen Morris, MD, FACS, Jeffrey Saffle, MD, FACS Although colloid was a component of the original Parkland formula, it has been omitted from standard Parkland resuscitation for over 30 years. However, some burn centers use colloid as “rescue” therapy for patients who exhibit progressively increasing crystalloid re- quirements, a phenomenon termed “fluid creep.” We reviewed our experience with this pro- cedure. With Institutional Review Board approval, we reviewed all adult patients with >20%TBSA burns admitted from January 1, 2005, through December 31, 2007, who com- pleted formal resuscitation. Patients were resuscitated using the Parkland formula, adjusted to maintain urine output of 30 to 50 ml/hr. Patients who required greater amounts of fluid than expected were given a combination of 5% albumin and lactated Ringer’s until fluid requirements normalized. Results were expressed as an hourly ratio (I/O ratio) of fluid infusion (ml/kg/%TBSA/hr) to urine output (ml/kg/hr). Predicted values for this ratio vary for individual patients but are usually less than 0.5 to 1.0. Fifty-two patients were reviewed, of whom 26 completed resuscitation using crystalloid alone, and the remain- ing 26 required albumin supplementation (AR). The groups were comparable in age, gen- der, weight, mortality, and time between injury and admission. AR patients had larger total and full-thickness burns and more inhalation injuries. Patients managed with crystalloid alone maintained mean resuscitation ratios from 0.13 to 0.40, whereas AR patients demon- strated progressively increasing ratios to a maximum mean of 1.97, until albumin was started. Administration of albumin produced a dramatic and precipitous return of ratios to within predicted ranges throughout the remainder of resuscitation. No patient developed abdominal compartment syndrome. Measuring hourly I/O ratios is an effective means of expressing and tracking fluid requirements. The addition of colloid to Parkland resuscita- tion rapidly reduces hourly fluid requirements, restores normal resuscitation ratios, and ameliorates fluid creep. This practice can be applied selectively as needed using predeter- mined algorithms. (J Burn Care Res 2010;31:40 – 47) Since World War II, care of the burn patient has evolved in many ways. One of the key components of burn care that has continually changed and remains controversial is fluid resuscitation. Although large- volume resuscitation is universally accepted, there are varying components of this practice that are widely debated. Traditionally, crystalloid intravenous fluid (IVF) is given to those suffering from acute burn injury to compensate for the intravascular losses that occur be- cause of capillary leak. The Parkland formula, origi- nally developed by Charles Baxter over 30 years ago, has been the most widely used method for predicting fluid requirements for the first 24 hours following cutaneous burn injury. 1,2 Since its introduction, the original Parkland formula has been modified several ways, including the “consensus formula,” in which patients are calculated to require 2 to 4 ml of lactated Ringer’s (LR) solution per kilogram of body weight per percentage of burn injury. 3 The consensus for- mula is widely accepted and is used in some form in From the Burn Trauma ICU, Department of Surgery, University of Utah College of Medicine, Salt Lake City, Utah. Presented at the 41st Annual Meeting of the American Burn Association, San Antonio, TX; March 24 –27, 2009. Address correspondence to Jeffrey R. Saffle, MD, FACS, Department of Surgery, 3B-306, University of Utah Health Center, 50 North Medical Drive, Salt Lake City, Utah 84132. Copyright © 2010 by the American Burn Association. 1559-047X/2010 DOI: 10.1097/BCR.0b013e3181cb8c72 40