Burn Centre, Percy Military Teaching Hospital, Clamart, France; Val-de-Grâce Military Medical Academy, Paris, France.
Centre for Global Burn Injury Policy and Research, Swansea University, Wales, UK; Interburns, International Network for Training, Education and Research in Burns, Swansea, Wales, UK.
Burns. 2021 Dec;47(8):1730-1738. doi: 10.1016/j.burns.2021.02.022. Epub 2021 Feb 27.
Burn fluid resuscitation guidelines have not specifically addressed mass casualty with resource limited situations, except for oral rehydration for burns below 40% total body surface area (TBSA). The World Health Organization Technical Working Group on Burns (TWGB) recommends an initial fluid rate of 100 mL/kg/24 h, either orally or intravenously, beyond 20% TBSA burned. We aimed to compare this formula with current guidelines.
The TWGB formula was numerically compared with 2-4 mL/kg/%TBSA for adults and the Galveston formula for children.
In adults, the TWGB formula estimated fluid volumes within the range of current guidelines for burns between 25 and 50% TBSA, and a maximal 20 mL/kg/24 h difference in the 20-25% and the 50-60% TBSA ranges. In children, estimated resuscitation volumes between 20 and 60% TBSA approximated estimations by the Galveston formula, but only partially compensated for maintenance fluids. Beyond 60% TBSA, the TWGB formula underestimated fluid to be given in all age groups.
The TWGB formula for mass burn casualties may enable appropriate fluid resuscitation for most salvageable burned patients in disasters. This simple formula is easy to implement. It should simplify patient management including transfers, reduce the risk of early complications, and thereby optimize disaster response, provided that tailored resuscitation is given whenever specialized care becomes available.
烧伤液体复苏指南并未特别针对资源有限的大规模伤亡情况进行处理，除了 40%以下总体表面积（TBSA）的烧伤采用口服补液。世界卫生组织烧伤问题技术工作组（TWGB）建议，在烧伤面积超过 20% TBSA 时，初始液体率为 100mL/kg/24h，口服或静脉内给予。我们旨在比较该公式与当前指南。
TWGB 公式与成人的 2-4mL/kg/%TBSA 以及儿童的加尔维斯顿公式进行数值比较。
在成人中，TWGB 公式在 25%至 50%TBSA 之间的烧伤范围内，以及在 20%-25%和 50%-60%TBSA 范围内，液体量估计值在当前指南范围内，最大差异为 20mL/kg/24h。在儿童中，20%至 60%TBSA 的估计复苏量接近加尔维斯顿公式的估计量，但仅部分补偿维持液。超过 60%TBSA 时，TWGB 公式低估了所有年龄段患者所需的液体量。
TWGB 公式适用于大规模烧伤伤员，可对灾害中大多数可挽救的烧伤患者进行适当的液体复苏。这个简单的公式易于实施。它应该简化患者管理，包括转院，降低早期并发症的风险，从而优化灾害应对，前提是在获得专门护理时，给予量身定制的复苏。
