Dr Tim Wang¹, Dr Aruna Wijewardena¹, Dr Bish Soliman¹, Dr Jeon Cha¹

¹Royal North Shore Hospital, Sydney, Australia

Abstract:

Background: Morbidly obese patients take a longer time to reach end-points of resuscitation and normalise their metabolic derangements.(Rae et al., 2013) The Parkland formula remains the most prevalent formula used in determining fluid needs during acute burns resuscitation. Its application in the obese patient is challenging due to difficulty estimating correct total body surface area burned (TBSA) and determining which body weight (ideal vs actual) to use in the calculation.

Methods: A systematic review was conducted on all articles pertaining to burns fluid resuscitation in the obese patient with a focus on methods of TBSA estimation and body weight modifications used in Parkland formula calculation.

Results: Using actual body weight results in overestimation of volume requirements whilst ideal body weight results in significant underestimation.(Rae et al., 2013, Rosenthal et al., 2018) Using adjusted ideal body weight during initial resuscitation followed by a titration algorithm may limit over-resuscitation without increase in acute kidney injury.(Lindsey et al., 2020) The “rule of nines” and 1% palmar rule are inaccurate in the measurement of TBSA in the obese patient.(Neaman et al., 2011) The former over-estimates the size of the head and arms, whilst underestimating the size of the trunk and legs.(Neaman et al., 2011) Alternatives proposed includes the “rule of fives”, “rule of sevens” and the Neaman modification.

Conclusion: Effective fluid resuscitation of the obese burns patient requires modifications to both TBSA and body weight estimation methodology to achieve best outcomes.

Biography:

Consultant Plastic and Burns Surgeon at Royal North Shore Hospital Sydney with an interest in microsurgery, peripheral nerve surgery, burns surgery and scarring.