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A Standardized Procedure of Dressing Management for Toxic Epidermal Necrolysis
Published on: March 14, 2025
[Transfusional requirements for escharectomy in burned children]
Analía R Julia1, Hugo Basílico, Gustavo Magaldi
1Unidad de Quemados, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan. heiroa@intramed.net
Insights
Pediatric burn escharectomies require approximately 2 ml/kg/% excised of red blood cells and 1 ml/kg/% excised of plasma. Platelet transfusions should be determined on a case-by-case basis for pediatric burn patients.
Area of Science:
- Pediatric Surgery
- Burn Management
- Transfusion Medicine
Context:
- Extensive burns necessitate early surgical excision for improved outcomes.
- Massive resections during burn escharectomy can lead to significant blood loss requiring correction.
- Accurate assessment of blood component needs is crucial for pediatric burn care.
Purpose:
- To quantify blood component utilization during pediatric burn escharectomies.
- To correlate blood product usage with surgical parameters like percentage of excised body surface area.
- To investigate the influence of infection, grafting, and timing of surgery on blood component requirements.
Summary:
- This study analyzed blood component use in 51 pediatric patients undergoing 94 escharectomies.
- Average requirements were 2.07 ml/kg/% excised for red blood cells (60% intraoperative) and 0.7 ml/kg/% excised for plasma.
- Platelet transfusions were needed in only 12% of cases, with no significant variation based on infection, grafting, or time post-burn.
Impact:
- Establishes evidence-based guidelines for red blood cell and plasma transfusion volumes in pediatric burn escharectomy.
- Highlights the low incidence of platelet transfusion necessity in this patient group.
- Informs perioperative blood management strategies for pediatric burn surgery, optimizing resource allocation and patient safety.
Introduction:
Early excision has considerably improved outcome in extensive burns, but massive resections usually mean copious bleeding that must be conveniently corrected. The purpose of this study was to measure blood component use during escharectomies in children.
Material And Methods:
All pediatric patients with acute burns excised at the Burn Unit of the Hospital Garrahan during one year were included. Volume of blood component used during and immediately after surgery was analyzed and related to percent excised, time post-burn, and the coexistence of infection and autograft at the time of excision.
Results:
Ninety-four surgeries in 51 children aged 0-14 years with total burned body surface areas of 5-80% who underwent resections of 3-70% were studied. Total blood use (intra + post-operatively) was 2.07 ml/kg/%excised for red blood cells (60% during surgery) and 0.7 ml/kg/% excised for plasma. Only 12% of patients required platelet transfusion. There was no significant requirement variation with the existence of infection, grafting or time post-burn.
Conclusions:
Approximately 2 ml/kg/% excised of red blood cells (2/3 for surgery) and 1 ml/kg/% excised of plasma are needed for escharectomies in children. The need for platelets must be judged considering the individual patient.
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