Current Thoughts on Burn Resuscitation.

The optimal treatment of burn shock is still unresolved. The problem of "fluid creep" continues despite modern devices that fail to improve outcomes over hourly urine output. Colloids, especially albumin, reduce fluid requirements. Albumin can be used either immediately at the start of resuscitation, or as a "rescue" when crystalloid use is excessive. Several studies confirm that when crystalloid resuscitation is "out of control" the majority of caregivers will add albumin to reduce fluid rates. A multi-center trial is underway comparing crystalloids with albumin to confirm the benefit of colloids. The next question is whether albumin or plasma is as the better colloid choice.
Competing Interests: Disclosure The author is Principle Investigator of one current Department of Defense Grant (W81XWH-19-1-664.JW180038, Acute Burn ResUscitation Prospective Multicenter Trial 2 [ABRUPT2]) (ClinicalTrials.gov – NCT04356859) that compares the use of albumin to lactated Ringer’s solution, and one completed Department of Defense grant (W81XWH-16-2-0048, Acute Burn ResUscitation Prospective Multicenter Trial [ABRUPT]) (ClinicalTrials.gov – NCT03144427) that are described in the paper.
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