TY - JOUR

T1 - Simple derivation of the initial fluid rate for the resuscitation of severely burned adult combat casualties

T2 - In silico validation of the rule of 10

AU - Chung, Kevin K.

AU - Salinas, José

AU - Renz, Evan M.

AU - Alvarado, Ricardo A.

AU - King, Booker T.

AU - Barillo, David J.

AU - Cancio, Leopoldo C.

AU - Wolf, Steven E.

AU - Blackbourne, Lorne H.

PY - 2010/7

Y1 - 2010/7

N2 - Background: In practice, current burn resuscitation formulas, designed to estimate 24-hour fluid resuscitation needs, provide only a starting point for resuscitation. To simplify this process, we devised the "rule of 10" to derive the initial fluid rate. Methods: We performed an in silico study to determine whether the rule of 10 would result in acceptable initial fluid rates for adult patients. A computer application using Java (Sun Microsystems Inc., Santa Clara, CA) generated a set of 100,000 random weights and percentage of total body surface area (%TBSA) values with distributions matching the model characteristics with which the initial fluid rate was calculated using the rule of 10. The initial rate for 100,000 simulations was compared with initial rates calculated by using either the modified Brooke (MB, 2 mL/kg/%TBSA) or the Parkland (PL, 4 mL/kg/%TBSA) formulas. Results: Analysis of calculated initial fluid rates using the rule of 10 showed that 87.8% (n = 87,840) of patients fell between the initial rates derived by the MB and the PL formulas. Less than 12% (n = 11,502) of patients had rule of 10 derived initial rates below the MB. Among these patients, the median difference of the initial rate was 14 mL/hr (range, 2-212 mL/hr). Among those who had initial rule of 10 calculated rates greater than the PL formula (<1%, n = 658), the median difference in rate was 33 mL/hr (range, 1-213 mL/hr), with a mean %TBSA of 21% ± 1% and mean weight of 130 kg ± 11 kg. Conclusions: For the majority of adult burn patients, the rule of 10 approximates the initial fluid rate within acceptable ranges.

AB - Background: In practice, current burn resuscitation formulas, designed to estimate 24-hour fluid resuscitation needs, provide only a starting point for resuscitation. To simplify this process, we devised the "rule of 10" to derive the initial fluid rate. Methods: We performed an in silico study to determine whether the rule of 10 would result in acceptable initial fluid rates for adult patients. A computer application using Java (Sun Microsystems Inc., Santa Clara, CA) generated a set of 100,000 random weights and percentage of total body surface area (%TBSA) values with distributions matching the model characteristics with which the initial fluid rate was calculated using the rule of 10. The initial rate for 100,000 simulations was compared with initial rates calculated by using either the modified Brooke (MB, 2 mL/kg/%TBSA) or the Parkland (PL, 4 mL/kg/%TBSA) formulas. Results: Analysis of calculated initial fluid rates using the rule of 10 showed that 87.8% (n = 87,840) of patients fell between the initial rates derived by the MB and the PL formulas. Less than 12% (n = 11,502) of patients had rule of 10 derived initial rates below the MB. Among these patients, the median difference of the initial rate was 14 mL/hr (range, 2-212 mL/hr). Among those who had initial rule of 10 calculated rates greater than the PL formula (<1%, n = 658), the median difference in rate was 33 mL/hr (range, 1-213 mL/hr), with a mean %TBSA of 21% ± 1% and mean weight of 130 kg ± 11 kg. Conclusions: For the majority of adult burn patients, the rule of 10 approximates the initial fluid rate within acceptable ranges.

KW - Adult burn patients

KW - Fluid rate

KW - Resuscitation

KW - Rule of 10

UR - http://www.scopus.com/inward/record.url?scp=77954808683&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e3181e425f1

DO - 10.1097/TA.0b013e3181e425f1

M3 - Article

C2 - 20622619

AN - SCOPUS:77954808683

SN - 0022-5282

VL - 69

SP - S49-S53

JO - Journal of Trauma - Injury, Infection and Critical Care

JF - Journal of Trauma - Injury, Infection and Critical Care

IS - SUPPL. 1

ER -