When should fluid resuscitation be initiated in burn patients?

Initiating fluid resuscitation in burn patients is critical for maintaining blood volume and organ perfusion, particularly in cases of extensive burns. When burns cover more than 20% of the Total Body Surface Area (TBSA), there is a substantial risk of hypovolemic shock due to fluid loss from the damaged skin.

In such cases, the body's ability to maintain adequate blood pressure and perfusion to vital organs is compromised. Fluid resuscitation aims to compensate for these losses and to prevent complications such as renal failure and shock. Research and clinical guidelines have established that burns covering greater than 20% TBSA significantly increase the need for aggressive fluid management to promote recovery and reduce mortality risk.

Burns covering less than 20% TBSA may not require as aggressive an approach to fluid resuscitation, as the associated fluid loss and risk of shock are less pronounced. Additionally, relying solely on the degree of burn severity (such as only assessing third-degree burns) may overlook other critical factors impacting a patient's overall condition and the extent of systemic effects from the injury.