Benicke Markus, Perbix Walter, Lefering Rolf, Knam Friedrich, Ipaktchi Kyros R, Tannapfel Andrea, Neugebauer Edmund A M, Spilker Gerald
Department of Plastic and Reconstructive Surgery with Burn Unit, City Hospital Cologne-Merheim, Ostmerheimer Strasse 200, Cologne, Germany.
Burns. 2009 Feb;35(1):30-5. doi: 10.1016/j.burns.2008.06.006. Epub 2008 Oct 21.
The Parkland-Baxter formula is a widely utilized resuscitation guideline for the initial management of fluid deficits in burn victims. Implementation of resuscitation formulas has helped to reduce the incidence of shock and hypovolemic organ failure such as acute renal failure in the setting of burn trauma. However, it has been shown that indiscriminate implementation of these formulas may inappropriately suit individual patient's requirements. In our experience resuscitation by the Parkland formula often forced corrections in order to reach predefined resuscitation goals.
Given these findings we felt the need to refine formula based resuscitation strategies.
Reviewing a subset of 81 burn admissions we screened for predictive parameters in addition to total body surface area burned (TBSA burned) and body weight influencing resuscitation volume requirements.
Using multivariate linear regression analysis (MRA) various parameters were integrated in a stepwise forward mathematical selection procedure resulting in a modified resuscitation formula.
A new formula including body weight, TBSA burned, inhalation injury (IHI), high blood alcohol level (BAL) and a compensating factor for advanced age was set up. The new formula was compared to the original Parkland formula. Both were assessed for predictive reliability (PR(+/-20%)). Using this strategy we were able to improve PR(+/-20%) from 28.4% to 51.9%.
Optimal fluid resuscitation of severe burn victims is a complex clinical challenge. Rigid-formula based resuscitation schemes often fail to match all subtleties of current clinical practice but need to provide a reliable starting point for fluid resuscitation. We demonstrate a new multifactorial formula resulting in a better guide to initial fluid resuscitation.
帕克兰-巴克斯特公式是广泛用于烧伤患者液体缺失初始管理的复苏指南。复苏公式的实施有助于降低烧伤创伤情况下休克和低血容量性器官衰竭（如急性肾衰竭）的发生率。然而，已表明不加区分地实施这些公式可能无法恰当满足个体患者的需求。根据我们的经验，使用帕克兰公式进行复苏常常需要强行调整以达到预设的复苏目标。
鉴于这些发现，我们认为有必要完善基于公式的复苏策略。
回顾81例烧伤入院患者的一个子集，我们除了筛查烧伤总面积（TBSA烧伤）和影响复苏液体需求量的体重外，还筛查了预测参数。
使用多元线性回归分析（MRA），将各种参数纳入逐步向前的数学选择程序，得出一个改良的复苏公式。
建立了一个新公式，包括体重、TBSA烧伤、吸入性损伤（IHI）、高血酒精水平（BAL）和一个针对高龄的补偿因子。将新公式与原始帕克兰公式进行比较。两者都评估了预测可靠性（PR（±20%））。使用该策略，我们能够将PR（±20%）从28.4%提高到51.9%。
严重烧伤患者的最佳液体复苏是一项复杂的临床挑战。基于严格公式的复苏方案往往无法匹配当前临床实践的所有细微之处，但需要为液体复苏提供一个可靠的起点。我们展示了一个新的多因素公式，能更好地指导初始液体复苏。
