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Table 4 Recommendations regarding fluid resuscitation in severe burns’ patients.

From: Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA)

Type of fluid Recommendation
1. Normal saline Given the fact that fluid resuscitation in burn management requires large volumes, the use of saline cannot be recommended in a burn resuscitation protocol
2. Balanced crystalloid Based on the available evidence, balanced crystalloid solutions are a pragmatic initial resuscitation fluid in the majority of acutely ill (and burn) patients
3. Semi-synthetic colloids Given the recent data concerning the use of semi-synthetic colloids (and starches in particular), their use in critically ill patients, including burn patients, cannot be recommended
4. Albumin Based on the available evidence the use of albumin 20% can be recommended in severe burns, especially in the deresuscitation phase guided by indices of capillary leak, body weight, (cumulative) fluid balance, fluid overload, extravascular lung water and IAP
5. Hypertonic solutions To this day, there is insufficient evidence to reach consensus regarding the safety of hypertonic saline in burn resuscitation. Whenever using hypertonic saline in clinical practice, however, close monitoring of sodium levels is highly advised