At what percentage of total body surface area (TBSA) burned should fluid resuscitation be initiated?

Fluid resuscitation is a critical intervention for patients who have sustained burns. The initiation of fluid resuscitation is based on the extent of burn injury, specifically the percentage of total body surface area (TBSA) affected by burns. When burns account for 20% or more of TBSA in adults, the risk of hypovolemic shock increases significantly, necessitating immediate fluid resuscitation to restore circulatory volume and prevent complications.

The rationale for starting resuscitation at this threshold is that burns can cause significant fluid loss through the damaged skin, leading to a decrease in circulating blood volume. This can compromise vital organ perfusion and potentially lead to life-threatening conditions. By initiating fluid resuscitation at 20% TBSA, healthcare providers can counteract these effects more effectively and ensure better patient outcomes.

In pediatric populations, the threshold for initiating fluid resuscitation may differ, but for adult patients, 20% TBSA is the critical benchmark established by guidelines on burn management and tactical combat casualty care. This evidence-based approach helps ensure that interventions are timely and appropriate given the severity of the injury.