The Parkland formula under fire: is the criticism justified?

Abstract

Controversy has continued regarding the practicality and accuracy of the Parkland burn formula since its introduction over 35 years ago. The best guide for adequacy of resuscitation is urine output (UOP) per hour. A retrospective study of patients resuscitated with the Parkland formula was conducted to determine the accuracy (calculated vs. actual volume) based on UOP. A review of burn resuscitation from a single institution over 15 years was conducted. The Parkland formula was defined as fluid resuscitation of 3.7 to 4.3 ml/kg/% total body surface area (TBSA) burn in the first 24 hours. Adequate resuscitation was defined as UOP of 0.5 to 1.0 ml/kg/hr. Over-resuscitation was defined as UOP > 1.0 ml/kg/hr. Patients were stratified according to UOP. Burns more than 19% TBSA were included. Electrical burns, trauma, and children (<15 years) were excluded. Four hundred and eighty-three patients were reviewed. Forty-three percent (n = 210) received adequate resuscitation. Forty-eight percent (n = 233) received over-resuscitation. The mean fluid in the adequately and over-resuscitated groups was 5.8 and 6.1 ml/kg/%, respectively (P = .188). Mean TBSA and full thickness burns in the adequately and over-resuscitated groups were 38 and 43%, and 19 and 24%, respectively (P < .05). Inhalation injury was present in 12 and 18% (P = .1). Only 14% of adequately resuscitated and 12% of over-resuscitated patients met Parkland formula criteria. The mean Ivy index in the adequately and over-resuscitated groups was 216 and 259 ml/kg (P < .05). There was no significant difference in complication rates (80 vs. 82%) or mortality (14 vs. 17%). The actual burn resuscitation infrequently met the standard set forth by the Parkland formula. Patients commonly received fluid volumes higher than predicted by the Parkland formula. Emphasis should be placed not on calculated formula volumes, as these should represent the initial resuscitation volume only, but instead on parameters used to guide resuscitation. The Parkland formula only represents a resuscitation "starting" point. The UOP is the important parameter.