Related Experiment Video
Updated: May 29, 2026
Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome (ARDS)
Published on: April 7, 2021
Respiratory failure after pediatric scald injury
Dorothy V Rocourt1, Mark Hall, Brian D Kenney
1Department of Pediatric Surgery, Penn State Hershey Children's Hospital, Penn State Milton S. Hershey Medical Center, PO Box 850, Hershey, PA 17033, USA.
Insights
Pediatric patients with severe scald burns can develop respiratory failure without direct lung injury. Factors like young age, small size, and inflammation may contribute to this critical condition, necessitating mechanical ventilation in 5% of cases.
Area of Science:
- Pediatric Burn Care
- Respiratory Failure Etiology
- Critical Care Medicine
Background:
- A subset of pediatric patients with scald burns experiences respiratory failure despite no direct airway or lung injury.
- Understanding the causes of this respiratory failure is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To investigate the etiology of respiratory failure in pediatric patients with severe scald burns.
- To identify risk factors associated with the need for mechanical ventilation in this population.
Main Methods:
- Retrospective review of pediatric patients with scald burns exceeding 10% total body surface area (TBSA).
- Data collected included patient demographics, burn characteristics, resuscitation details, injury severity, and ventilation requirements.
Main Results:
- Out of 232 patients, 12 (5%) required mechanical ventilation.
- Intubation was not required in patients older than 3 years or with burns less than 15% TBSA.
- Fluid overload was not directly linked to respiratory failure requiring mechanical ventilation.
Conclusions:
- This study presents the largest series of pediatric scald burn patients requiring mechanical ventilation without direct airway injury.
- Respiratory failure in these cases is likely multifactorial, involving fluid resuscitation, young age, small patient size, and systemic inflammatory response.
- Early identification and management of these contributing factors are essential for pediatric burn care.
Objective:
A subset of children with scald burns develops respiratory failure despite no direct injury to the lungs. We examined these patients in an effort to elucidate the etiology of the respiratory failure.
Methods:
The charts of pediatric patients with greater than 10% total body surface area (TBSA) scald burns were reviewed. Age, weight, burn distribution, percentage of TBSA burned, resuscitation volumes, Injury Severity Score, evidence of abuse, length of stay, days in the intensive care unit, and time and duration of intubation were recorded.
Results:
Two hundred thirty-two patients met our inclusion criteria. Of these, 220 patients did not require intubation, and 12 of the patients did. No patient older than 3 years or with burns less than 15% TBSA required intubation. Fluid over resuscitation was not directly associated with respiratory failure requiring mechanical ventilation.
Conclusions:
We report the largest published series of patients with scald burns requiring mechanical ventilation in the absence of direct airway injury. Five percent of pediatric patients required mechanical ventilation after scald injury. We believe that a combination of causes including fluid resuscitation, young patient age, small patient size, and possible activation of the systemic inflammatory immune response may be responsible for the respiratory failure.
Related Concept Videos
01:21Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:30Acute Respiratory Failure-III
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:23Acute Respiratory Failure-IV
01:17Pulmonary Cycle: Exhalation