Abstract
The authors suggest that initial burn resuscitation is made difficult by using existing American Burn Association (ABA) guidelines recommending the Parkland or modified Brooke formula (2 to 4 mL of lactated Ringer's [LR] solution per hour multiplied by the patient's body weight and percentage of total body surface area [TBSA] burned, where half is given over the first 8 hours and the other half over the remaining 16 hours). They offered an alternative formula—one that they believed to be easier to remember—and used a computer model to compare it with ABA guidelines. The “rule of 10” predicts an initial fluid rate (in mL of LR/h) equal to the percentage of TBSA estimated to the nearest 10 and multiplied by 10 for patients between 40 and 80 kg. For every 10 kg above 80 kg, 100 mL/h should be added. For example, a 50% TBSA burn would be initially resuscitated with 500 mL of LR/h.
A computer model generated 100 000 sample burns based on the distribution of burns greater than 20% seen at the US Army Institute of Surgical Research between 2003 and 2008. In this distribution, 95% of the people had a weight range between 46 and 130 kg. Based on this population and using the “rule of 10,” 11.5% of patients fell below the modified Brooke formula and 0.7% above the Parkland formula. These outliers resulted from the heaviest patients or largest burns.
The authors state that all of these rules provide an initial starting point for resuscitation and that urine output should be used to determine further resuscitation. The “rule of 10” calculates similar volumes in this sample population; however, further study is needed to prove that it is better implemented or easier to remember.
(J Trauma. 2010;69(suppl 1):S49–S54) KK Chung, J Salinas, EM Renz, et al.
Prepared By Anil Menon, MD, UTMB/NASA Aerospace Medicine Fellow, Galveston, TX, USA