Skip to main content

Hemodynamic management of critically ill burn patients: an international survey

Fluid resuscitation is a cornerstone of the initial management of severely burned patients with the dual purpose of avoiding both under- and over-resuscitation [1,2,3]. There is a lack of consensus regarding the ideal amount and type of fluid and vasopressor use during initial resuscitation in this population [4, 5].

This international survey focuses on the current practices regarding hemodynamic management of severely burned adult patients (total body surface burn area (TBSA) > 20%, with mechanical ventilation) in the early phase after injury.

The study was designed as an electronic survey addressed to intensive care unit (ICU) physicians. Experts of the European Society of Intensive Care Medicine (ESICM) Burn ICU working group were invited to review the original survey. The final questionnaire (32 questions) is provided in Additional file 1. A link to an electronic questionnaire was sent to all ESICM members (with reminding emails on a bimonthly frequency) and was posted on the ESICM website. The link was active between 31 August and 18 October 2017.

There were 173 total respondents to the questionnaire. The respondents were from 58 different countries (72% were high-income countries) with most in Europe (62%). The background of the respondents was mainly intensive care (61%) and anesthesiology (31%). Most of the respondents (61%) declared working in a mixed ICU, and 60% of the responders worked in centers with less than 50 adult burn patients admitted annually. Additional file 2 summarizes the difference in participant responses between burn centers and nonspecialized centers. In 76% of the cases, a local protocol for fluid resuscitation was used. The Parkland formula (4 ml/kg/%TBSA) is used to start volume therapy on admission by 54% of the responders. In the first 48 h, the five most frequently used parameters to guide volume therapy are represented in Fig. 1a. Fifty five % of the respondents declared monitoring cardiac output and 65% among them use echocardiography. Techniques used to monitor cardiac output continuously are presented in Fig. 1b. The most commonly used crystalloid and colloid were respectively Ringer Lactate and albumin 20%. Triggers to initiate colloid infusion are presented in Fig. 1c. While considering other strategies to reduce fluid requirements, 80% of responders consider early norepinephrine administration (Fig. 1d).

Fig. 1

a The five most frequently used parameters to guide volume therapy in severely burned patients. b Techniques used to monitor cardiac output continuously. c Triggers to initiate colloid infusion. d Adjunctive therapies to reduce initial volume administration. ARDS acute respiratory distress syndrome, MAP mean arterial pressure, PPV pulse pressure variation, SVV stroke volume variation, TBSA total body surface burn area, UO urine output

The results of this international survey highlight the use of albumin (> 60%) and vasopressors (80%) during the early resuscitation phase. Heterogeneous results were reported regarding monitoring strategies, early vasopressors, and albumin use between burn centers and nonspecialized centers. Large clinical trials should be initiated in the near future to determine optimal strategies to treat burn-related shock.



European Society of Intensive Care Medicine


Intensive care unit


Total body surface burn area


  1. 1.

    Soussi S, Deniau B, Ferry A, Levé C, Benyamina M, Maurel V, et al. Low cardiac index and stroke volume on admission are associated with poor outcome in critically ill burn patients: a retrospective cohort study. Ann Intensive Care. 2016;6(1):87.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Mason SA, Nathens AB, Finnerty CC, Gamelli RL, Gibran NS, Arnoldo BD, et al. Inflammation and the host response to injury collaborative research program. Hold the pendulum: rates of acute kidney injury are increased in patients who receive resuscitation volumes less than predicted by the Parkland equation. Ann Surg. 2016;264:1142–7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Klein MB, Hayden D, Elson C, Nathens AB, Gamelli RL, Gibran NS, et al. The association between fluid administration and outcome following major burn: a multicenter study. Ann Surg. 2007;245:622–8.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Guilabert P, Usúa G, Martín N, Abarca L, Barret JP, Colomina MJ. Fluid resuscitation management in patients with burns: update. Br J Anaesth. 2016;117(3):284–96.

    Article  PubMed  CAS  Google Scholar 

  5. 5.

    Legrand M, Guttormsen AB, Berger MM. Ten tips for managing critically ill burn patients: follow the RASTAFARI! Intensive Care Med. 2015;41(6):1107–9.

    Article  PubMed  Google Scholar 

Download references


This survey was endorsed by the European Society of Intensive Care Medicine. We thank the ESICM Burn ICU working group experts for their involvement and help in conducting this survey.

Availability of data and materials

Figure 1 is original and has never been published.

Author information





SS and ML collected and analyzed the data. The manuscript was written by SS and ML and critically revised by all coauthors and ESICM Burn ICU working group experts. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sabri Soussi.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Additional files

Additional file 1:

Survey questions. (PDF 131 kb)

Additional file 2:

Comparison of participant responses between burn centers and nonspecialized centers. CO cardiac output, n number of respondents per group. The results are reported as numbers and percentages (%). The chi2 and Fischer tests were used as appropriate (p < 0.05). (PDF 155 kb)

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Soussi, S., Berger, M.M., Colpaert, K. et al. Hemodynamic management of critically ill burn patients: an international survey. Crit Care 22, 194 (2018).

Download citation