Albumin resuscitation in burns: a hybrid regime to mitigate fluid creep

Abstract

Introduction: Globally, many burns units moved away from colloid resuscitation in response to the Cochrane review (1998). Recent literature has introduced the concept of fluid creep: patients receiving volumes far in excess of the upper limit of the Parkland formula. The Cochrane review has been widely criticised, however, and we continued to use 4.5% human albumin solution after 8 h of crystalloid as a hybrid of Parkland and Muir & Barclay’s regime. Methods: Adult patients ⩾15% TBSA were identified from data prospectively entered into our database over a 5-year period (2003–2008). Medical notes and intensive care charts were reviewed comparing volumes of fluids received with requirement estimates. Adverse events were also documented. Results: A total of 72 cases with 34 sets of intensive care charts were analysed. Mean TBSA was 35.2% (range, 15–95%). A total of 75% survived; 3% were haemofiltered. Forty-one percent of patients were resuscitated using the Parkland formula alone, while 59% switched at 8 h post burn to the Muir and Barclay formula (Hybrid group). There was a significantly greater TBSA in the Hybrid group, but they received significantly less fluid volumes than the Parkland group ( P = 0.0363; the Hybrid group received 1.36 times calculated need vs. 1.62 in the Parkland group). Conclusion: Our patients still demonstrate fluid creep, but to a lesser extent than previously reported. Fluid creep has been mitigated but not eliminated through this strategy.