Fluid management methods for severely burned patients: a narrative review

Burn shock is a major early complication in the treatment of severely burned patients, and precise and timely fluid management is essential for survival. Traditional clinical indicators such as urine output, blood pressure, central venous pressure (CVP), and blood lactate are commonly used, but each has significant limitations. Invasive hemodynamic monitoring technologies, such as Pulmonary Artery Catheterization (PAC) and Pulse Contour Cardiac Output (PiCCO), have improved the accuracy of fluid assessment, but carry risks of infection and procedural complications and require experienced clinical interpretation within the context of the patient's overall condition. Non-invasive ultrasound-based methods, including critical care ultrasonography and the Venous Excess Ultrasound Score (VExUS), are emerging as promising alternatives, particularly in resource-limited settings. This review summarizes current methods for fluid management in severely burned patients, with a focus on the concepts of fluid responsiveness and fluid tolerance, and provides recommendations for clinical practice.