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Early fluid resuscitation improves outcomes in severely burned children
R E Barrow1, M G Jeschke, D N Herndon
1Department of Surgery, University of Texas Medical Branch and Shriners Hospital for Children, Galveston 77550, USA. rbarrow@sbi.utmb.edu
Insights
Early fluid resuscitation for children with severe burns (within 2 hours) significantly reduces sepsis, renal failure, cardiac arrest deaths, and overall mortality compared to delayed treatment.
Area of Science:
- Pediatric critical care medicine
- Burn management
- Trauma resuscitation
Background:
- Timely fluid resuscitation is crucial for reducing multiorgan failure and mortality in pediatric burn patients.
- Delayed fluid resuscitation (2-12 hours post-injury) may lead to adverse outcomes.
- This study investigates the impact of early versus delayed fluid resuscitation on specific complications and survival rates.
Purpose of the Study:
- To determine if fluid resuscitation within 2 hours of thermal injury attenuates renal failure, cardiac arrest, sepsis, and mortality in children.
- To compare outcomes between early (<2h) and delayed (>=2h) fluid resuscitation in pediatric burn patients.
Main Methods:
- Retrospective chart review of 133 children with >50% body surface area burns (1982-1999).
- Comparison of early (<2h) versus delayed (>=2h) fluid resuscitation groups.
- Statistical analysis using chi-squared test with Yates' correction and Bonferroni-corrected confidence intervals.
Main Results:
- Significantly higher incidence of sepsis, renal failure, non-survivors with cardiac arrest, and overall mortality in the delayed resuscitation group (P < 0.001).
- Early fluid resuscitation was associated with improved outcomes across all measured parameters.
Conclusions:
- Fluid resuscitation within 2 hours of thermal injury is a critical intervention.
- Early administration of fluids may be key in preventing multi-organ failure and reducing mortality in pediatric burn patients.
Background:
Recent evidence suggests that timely fluid resuscitation can significantly reduce multiorgan failure and mortality in thermally injured children. In this study, children who received fluid resuscitation within 2 h of a thermal injury were compared with children in which fluid resuscitation was delayed by 2-12 h. We hypothesized that fluid resuscitation given within 2 h of a thermal injury attenuates renal failure, cardiac arrest, cardiac arrest deaths, incidence of sepsis, and overall mortality.
Methods:
A retrospective chart review was made on 133 children admitted to our institute from 1982 to 1999 with scald or flame burns covering more than 50% of their body surface area. Comparisons between early (< 2 h of injury) or delayed (> or = 2 h of injury) fluid resuscitation were made in children experiencing renal failure, sepsis, non-survivors with cardiac arrest requiring pulmonary and advanced life support, and overall mortality. Comparisons were made using the chi2-test with Yates' continuity correction and joint binomial confidence intervals using the Bonferroni correction.
Results:
The incidence of sepsis, renal failure, non-survivors with cardiac arrest, and overall mortality was significantly higher in burned children receiving fluid resuscitation that was delayed by 2 h or more compared with those receiving fluid resuscitation within 2 h of thermal injury (P < 0.001).
Conclusions:
Data suggest that fluid resuscitation, given within 2 h of a thermal injury, may be one of the most important steps in the prevention of multi-organ failure and mortality.