Doc why is
fluid therapy so important in burn patients?
Neeraj,
Pune, India
Till the nineteenth
century burn patients had a high mortality rate. Why so many patients died in
the early stage of burn treatment remained a mystery till the concept of body
fluids in different compartments became clear. The body fluids lie in three
different compartments- vascular (within the blood vessels), intracellular (within
the cells) and extracellular space (outside the cells and blood vessels). A
constant shift of fluids keeps occurring to maintain a balance between these
three spaces and they remain in a state of equilibrium.
Among the organs of the
body the skin is the largest – about 15% of body weight and roughly 1.7 sq meter
in surface area. While the skin has a large number of functions like sensation,
physical protection, temperature regulation and others, the function of prevention
of fluid loss is critical to the burn management. Skin is made up of two
critical components –dermis and epidermis. Burns damage the integrity of the skin and
destroy its ability to manage fluids effectively. A lot of chemical substances
are released due to the burn injury which increases the leaking of fluids from
the vascular compartment to the extracellular space causing edema or tissue
swelling. This edema may be insignificant in small burns but in large burns or
burns more than 10 percent in children and 15 percent in adults can lead to loss of
water, albumin, sodium and red blood cells which can lead to a sudden fall in
the vascular space compartment pressure and shock (burn shock)- culminating in
death if not properly treated. The larger the TBSA of burn (Total body surface area) the greater the risk of death. The fluid loss need to be calculated correctly
and has to be replaced. Some historic events like the coconut groove fires and
other mass casualties led researches to understand the importance of fluid
management especially in the initial stage of burn management.
It is believed that every
year, 2.5 million Americans sustain a significant burn injury of which about 100,000
are hospitalized, and around 10,000 die. Burn researchers - Underhill and Moore
were the first to identify the concept of thermal injury- induced intravascular
fluid deficits in the early nineteenth century, followed by Evans who
introduced the fluid resuscitation formula in 1952. More than 50 percent of
patients with 50% TBSA or more died in the past and
now this mortality has come down to less than 10 percent – all because of the clear
understanding of fluid management in burn care.
(An original initiative in burn care education from asktheburnsurgeon!!!)
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