The Parkland formula , also known as Baxter formula , is a burn formula developed by Dr. Charles R. Baxter , used to estimate the amount of replacement fluid required for the first 24 hours in a burn patient so as to ensure the patient is hemodynamically stable. Only area covered by second-degree burns or greater is taken into consideration, as first-degree burns do not cause hemodynamically significant fluid shift to warrant fluid replacement.
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NCBI Bookshelf. Mitali Mehta ; Gregory J. Authors Mitali Mehta 1 ; Gregory J. Tudor 2. While major burns can cause considerable local damage and tissue injury, they can also result in a widespread inflammatory response that may affect the entire body. This section will focus specifically on fluid resuscitation in the critical burn patient.
Early and aggressive fluid resuscitation plays a fundamental role in the management of circulation in severe burn patients. Severe burn injuries trigger activation of the complement system and release of inflammatory and vasoactive mediators.
These mediators increase local and systemic capillary permeability, leading to the rapid displacement of intravascular fluids, electrolytes, and plasma proteins into the interstitial space. This extensive capillary leak results in large fluid shifts, intravascular fluid depletion, and significant edema of both burned and non-burned tissue. This response can begin within minutes and rapidly transpires over the first 24 hours after the injury occurs. Maximum intravascular hypovolemia and edema formation peaks at about 8—12 hours post-injury.
Massive systemic fluid loss, accompanied by decreased cardiac output and increased vascular resistance, eventually lead to critical hypoperfusion and subsequent tissue injury. The aim of fluid management in severe burn injuries is to maintain tissue perfusion and prevent end-organ ischemia in the earliest phases of burn shock. Prompt and adequate fluid resuscitation has consistently shown to decrease morbidity and mortality in victims of severe burns.
This improvement in outcomes has led to the development of many resuscitation protocols that aid in calculating initial fluid requirements. The Parkland formula, originated by Baxter and Shires in , remains the most well-known and widely used regimen to date  . The Parkland formula is used to calculate fluid resuscitation for critical burn patients. No absolute contraindications exist to use of the Parkland fluid. Peripheral intravenous access is the most efficient and least invasive way to administer high volumes of fluid.
If peripheral access is unattainable, central venous catheterization or an interosseous line must be a considered approach. Hypotension is often a late finding in burn shock. If a patient arrives hypotensive, always consider other traumatic causes of low blood pressure, such as hemothorax, cardiac tamponade, neurogenic shock, and internal abdominal and pelvic bleeding. The key here is to use the palm of the patient and not the palm of the provider. Delivery of half the volume is in the first 8 hours post-burn, and the remaining volume given over the next 16 hours.
Of note, the first eight hours of resuscitation is from the time of burn injury, not from the time of evaluation. Thus, the first half of total fluid amount may need to be administered at a faster rate if the patient has a delayed time before evaluation. Also, large volumes of normal saline solution can lead to hyperchloremic acidosis. Keep in mind that these formulas are meant to serve only as a guide for fluid resuscitation.
Several studies have shown that the Parkland formula may underestimate fluid requirements for certain critical burn patients. Patients with inhalation injuries, electrical burns, full-thickness burns, and those in who experience delayed resuscitation are among the specific patient populations that frequently need more fluid than what is calculated by the Parkland formula. Under resuscitation with fluids can lead to unstable vital signs, acute renal failure, and further end-organ injury.
Acute renal failure in burn settings may necessitate temporary dialysis. Over-resuscitation has been shown to increase complications such as abdominal and extremity compartment syndromes, cerebral edema, acute respiratory distress syndrome, a higher risk of sepsis, and multi-organ dysfunction.
Managing fluids in burn and trauma patients are challenging. Several studies have concluded patients who receive larger volumes of resuscitation fluid may be at higher risk for complications and death. As such, the rates of the fluid administration in major burns are a focus of controversy.
The Parkland formula offers a rational approach for adequate fluid resuscitation, however, the use of the formula must also include good clinical judgment. The best single indicator of adequate fluid resuscitation in major burn patients is hourly urine output. Recent practice guidelines for burn shock resuscitation consider supplementation of colloid-containing fluid after the first 24 hours post-burn, as it has shown to decrease overall fluid requirements.
To access free multiple choice questions on this topic, click here. Wallace Rule of Nines for determining percent of burned body surface area. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U.
StatPearls [Internet]. Search term. Introduction While major burns can cause considerable local damage and tissue injury, they can also result in a widespread inflammatory response that may affect the entire body. Anatomy and Physiology Severe burn injuries trigger activation of the complement system and release of inflammatory and vasoactive mediators. Indications The Parkland formula is used to calculate fluid resuscitation for critical burn patients.
Contraindications No absolute contraindications exist to use of the Parkland fluid. Complications Keep in mind that these formulas are meant to serve only as a guide for fluid resuscitation. Clinical Significance Managing fluids in burn and trauma patients are challenging. Enhancing Healthcare Team Outcomes The best single indicator of adequate fluid resuscitation in major burn patients is hourly urine output.
Questions To access free multiple choice questions on this topic, click here. Figure Wallace Rule of Nines for determining percent of burned body surface area. References 1. Current status of burn wound pathophysiology. Clin Plast Surg.
Moore FD. The body-weight burn budget. Basic fluid therapy for the early burn. North Am. Fluid management in major burn injuries.
Indian J Plast Surg. Zodda D. Calculated decisions: Parkland formula for burns. Pediatr Emerg Med Pract. Baxter CR. Fluid volume and electrolyte changes of the early postburn period. American Burn Association practice guidelines burn shock resuscitation. J Burn Care Res. Pruitt BA. Protection from excessive resuscitation: "pushing the pendulum back". J Trauma. Parkland Formula. In: StatPearls [Internet].
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Parkland Formula Calculator
Enter your email address and we'll send you a link to reset your password. Please fill out required fields. It is important to remember that all resuscitation formulas be used as a guide. Patients should be assessed frequently, with individual adjustments made to maintain adequate organ perfusion. Critically ill burn patients are best cared for at a dedicated burn center, particularly those with any of the following:. This is an unprecedented time.
NCBI Bookshelf. Mitali Mehta ; Gregory J. Authors Mitali Mehta 1 ; Gregory J. Tudor 2.