19. If possible, measure bladder pressures every 4 hours in intubated patients with >20% TBSA burns.5 Ensure the patient is in the supine position and follow the manufacturer's instructions for commercial kits; otherwise, use between 25 and 50 ml, being consistent in whatever volume is used, for serial measurements using a transducer located at the level of the symphysis pubis. Sustained bladder pressure >12 mmHg indicates early intra-abdominal hypertension and adjuncts such as colloid fluid should be considered. If the measured pressure is >20mmHg, the patient should be paralyzed and the measurement repeated. Persistent bladder pressures >20mmHg may indicate abdominal compartment syndrome (See Abdominal Compartment Syndrome below).
20. Combat casualties with burns often present with multi-system injury, to include inhalation injury, hemorrhage, and soft tissue trauma. Associated injuries may increase fluid needs above and beyond standard burn resuscitation formulas.
21. After approximately 24-72 hours, completion of resuscitation is marked by stabilizing hemodynamic parameters and reduction of IV fluid rate to a maintenance level. A well-resuscitated adult burn patient should follow commands, be hemodynamically stable, be tachycardic in the range of 110-130 beats per minute, and have UOP between 30-50 mL/hr. Acid-base balance should normalize, hematocrit should reveal a dilutional anemia, and pulses should be present in all extremities.