Parkland Formula

Extensive burns can cause considerable local damage, tissue injury, and a widespread inflammatory response affecting multiple organ systems. All severely burned patients are trauma patients first, thus should always be handled systematically with an initial focus on the ABCs (airway, breathing, and circulation). After the primary and secondary surveys are completed, early and aggressive fluid resuscitation is initiated.  The fundamental critical elements in burn resuscitation have progressively evolved as more information is unveiled through decades of research. Many formulas and their respective modifications have been modeled to reflect the changes in knowledge. In the 1930s, Frank Pell Underhill reported the fluid within a blister sustained from a burn to be of similar composition to plasma, which led to fluid resuscitation parameters based on patient weight and serum protein levels or hematocrit. Cope and Moore established a relationship between burn size and fluid resuscitation in the 1940s. Initially, plasma was favored as the principal constituent in resuscitation, with the Evan formula advocating for 2 mL per patient weight in kilograms per percentage of total body surface area (TBSA) burned, plus 2 L of intravenous maintenance fluids, half of which consisted of plasma and the other half of normal saline solution. The original Brooke formula continued to use 2 mL per weight in kilograms per percentage of TBSA burn but decreased the plasma requirements to one-fourth of the total fluids administered, and the remainder consisted of Lactated Ringer's solution.  Currently, the Parkland formula is the most frequently used burn resuscitation formula, followed by the Brooke formula. The Parkland formula uses 4 mL per patient weight in kilograms per percentage of TBSA burned with Lactated Ringer's solution as the primary crystalloid solution. However, despite the Parkland formula being the gold standard in burn resuscitation, controversy continues to remain as many studies seek to evaluate the accuracy and feasibility of the Parkland formula in burn resuscitation.