Good Afternoon.
    Burns management has always been a difficult zone for intensivists. Resuscitation and maintenance of hemodynamic stability seems to be a tight rope walk. There is no definite conclusion on "how much fluid is too much fluid" in Burns management. The concept of GIPS is particularly valid during management of severe Burns.
   This week we review a study on using a novel technique for optimum management of fluid therapy during Burns management.

An objective measure for the assessment and management of fluid shifts in acute major burns 
Kenworthy et al. Burns & Trauma (2018) 6:3 

Kenworthy et al evaluated the role of Bio Impedance Spectroscopy in identifying the volume status of patients presenting within 48 hrs of sustaining burn injuries greater than 15%. The investigators also attempted to factor in the dressings which are employed to cover the burn area. This was an observational study carried out over two years. it is  a small cohort of 21 patients. The resuscitation fluid of choice was Ringer Lactate and the target was to maintain a urine output 0.5–1.0 ml/kg/h for the first 36–48 h after burn injury.
Quantum of fluid was decided by the Parkland formula. Resistance patterns showed a significant decrease with increasing fluid. Fluid therapy was reflected in a minute to minute increase in Intra-cellular and Total Body Fluids. The percentage of burns also correlated well with the change in the resistance patterns. The investigators found that when a patient’s initial TBF increased by 1 L, R0 (Resistance at 0 frequency) decreased by 5.78 Ω (p < 0.01), R i ( intra cellular frequency) decreased 28.79 Ω (p  < 0.01) and R inf (Resistance at infinite frequency) decreased 5.31 Ω (p < 0.01). A calculator was developed to identify the change in parameters due to the dressing applied.
        This study seems to have identified a reliable marker of fluid characteristics and overload in Burns situation. The novelty of this study seems to be the ability to correlate the impedance characteristics real time in a minute to minute capture. The effect of the burns dressing was significant and needed to be interpreted with correction.

My comments:
1. BIS seems to be able to provide some answers to the eternal question of when to stop fluid resuscitation
2. It has given a direction for a targeted resuscitation of Burns without causing harm
3. Centres which deal with Burns on regular basis could try this method out to provide some guidance to the others.