Fluid and burns in children: What we know and what we do not know-a retrospective analysis of the German Burn Registry from 2015 to 2022.

Fluid resuscitation is of great importance in the management of major burns. Various formulae have been described for calculating fluid management, especially in severely burned patients. Although the Parkland formula is widely used, its efficacy and clinical value are discussed controversially. We investigated the impact of deviation from calculated fluid volume by Parkland formula and the maintenance i.v. fluid (Parkland*) on the outcome of burned pediatric patients. Patients aged < 16 years with thermal injuries included in the German Burn Registry between January 2016 and December 2022 with a total body surface area ≥ 15% were analyzed. Using mixed-effect negative binomial regression, the association between a deviation from Parkland* in the administered fluid volume and the primary outcome length of hospital stay was estimated-additionally adjusted for known risk factors. As a secondary outcome, we use in-hospital mortality, evaluated descriptively. In 86.5% of patients, the administered fluid volume was lower than Parkland*, with pronounced deviation in the seven patients who died in the hospital. Descriptively and based on mixed-effect negative binomial regression models, we found that a positive deviation from Parkland* increases the number of hospital days, whereas a negative deviation may decrease them.

Conclusion: Very little is known about the role of administered resuscitation volumes for the outcome of pediatric severely burned patients. This study observed a tendency to a restricted resuscitation and its potential benefits in terms of length of hospital stay.

What is known: • Fluid resuscitation is an important aspect of therapy in the acute phase of children with extensive burns. • The Parkland formula is routinely used formula for determining fluid requirements.

What is new: • 86.5 % received less volume than determined by Parkland and a tendency to restricted resuscitation and its potential benefits in terms of length of stay was observed. • There is still considerable lack of clarity, and a strictly individualized protocol with the support of formulas is of crucial importance.