demonstrated the use of tissue pCO2 monitoring to better correlate with tissue perfusion; however, its use is not commonplace as yet [10].

Clinical assessment is outdated; the use of resuscitation markers (BD, and lactate) is flawed; however, there are some which correlate well with overall risk of organ dysfunction and mortality. Newer techniques are under examination but have not gained wide acceptance for use. In conclusion, until a widely accepted method has been validated, care must be taken to incorporate as many tools as possible to determine adequate resuscitation.

1.2.3Fluid Over-resuscitation and Fluid Creep

The mainstay of fluid resuscitation remains crystalloid solutions (mainly Ringer’s lactate). However, consideration should be given to colloids if the resuscitation volumes are far exceeding those set out by the Parkland calculation as not to endure the consequences of fluid creep [18] such as:

•Abdominal compartment syndrome (ACS) [19–23]

•Extremity compartment syndrome [24]

•Respiratory failure and prolonged intubation [24]

•Pulmonary edema and pleural effusions [24]

•Orbital compartment syndrome [25]

One of the more dire consequences of fluid creep is ACS, with resultant mortal-

ity of 70–100 % [19, 22, 26–29]. Some of the strategies that can be utilized to decrease risk of ACS or prevent IAH (intra-abdominal hypertension) progressing to ACS in a burn patient are:

•Vigilant monitoring of fluid resuscitation – decrease fluid volumes as quickly as possible

•Monitor intra-abdominal pressures in all patients with >30 % TBSA burn

•Perform escharotomies on full-thickness torso burns and proceed to a “checkerboard pattern” if inadequate

•Consider aggressive diuresis if evidence of over-resuscitation

•Consider neuromuscular blockade to alleviate abdominal muscle tone

Should all the above strategies fail in lowering the intra-abdominal pressure, the

definitive solution is a decompressive laparotomy with aforementioned mortality of up to 100 % [19, 22, 26–29]. As a result, many have looked at other modes of resuscitation beyond the use of crystalloid solutions.

1.2.4Role of Colloids, Hypertonic Saline, and Antioxidants in Resuscitation

1.2.4.1 Colloids

As mentioned previously, the initial resuscitation is accomplished with mainly crystalloids. This is mainly as the consequence of burn pathophysiology, whereby there is a significant increase in the permeability of capillaries post-thermal injury with resultant movement shift of fluid into the interstitial space [30–35]. This increase