proteins in major burn resuscitation

Last reviewed 01/2018

The administration of a form of protein as a resuscitation fluid after major burns is somewhat controversial. Ideally, when given it should stay within the microcirculation to increase the intravascular oncotic pressure and so limit oedema. Unfortunately, the systemic microcirculation has increased permeability in the early stages of major burns and so there is a trend to commence protein colloid once the major fluid shift has occurred after 8-12 hours.

Protein colloid does not reduce the amount of interstitial oedema at the site of the burn. However, by increasing the intravascular oncotic pressure systemically, it reduces oedema in non-burned tissue.

Protein colloid is more likely to be required in the following scenarios:

• elderly
• inhalation injury
• severe burns (>50%)

Types of protein colloid include:

• albumin
• fresh frozen plasma
• heat fixed proteins