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Resuscitation using less fluid has no negative impact on hydration status in children with moderate sized scalds: a
Linda Hollén1, Karen Coy2, Andrew Day3
1Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, United Kingdom; The Scar Free Foundation Centre for Children's Burns Research, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, BS2 8BJ, United Kingdom.
Insights
Children with moderate burns treated with Biobrane dressings and reduced fluids showed safe hydration levels. This approach avoids over-resuscitation complications common with traditional fluid volumes.
Area of Science:
- Pediatric burn care
- Fluid resuscitation management
- Wound healing technologies
Background:
- Optimal fluid resuscitation is critical for pediatric burn patients.
- Current guidelines may lead to over-resuscitation in adults, prompting investigation in children.
- Biosynthetic dressings like Biobrane offer potential for improved burn management.
Purpose of the Study:
- To evaluate hydration status in pediatric burn patients managed with Biobrane and reduced fluid volumes.
- To compare clinical and laboratory hydration markers between reduced fluid (permissive hypovolaemia) and traditional resuscitation groups.
- To determine if reduced fluid resuscitation is safe and effective for moderate pediatric burns.
Main Methods:
- A single-center study comparing children with 10-19% BSA scalds treated with Biobrane and 80% maintenance fluids (permissive hypovolaemia group).
- Comparison with a historical cohort receiving traditional fluid resuscitation (TR group).
- Assessment of 24-hour urine output, serum sodium, urea, and creatinine as hydration markers.
Main Results:
- Permissive hypovolaemia (PH) group showed similar serum sodium and urine output to the traditional resuscitation (TR) group.
- The PH group had lower urea and higher creatinine levels than the TR group.
- Fewer patients in the PH group fell outside reference ranges for urea and creatinine compared to the TR group.
Conclusions:
- Children with moderate scalds managed with Biobrane can be safely treated with reduced fluid volumes.
- Permissive hypovolaemia, in conjunction with Biobrane, appears to maintain adequate hydration.
- This approach may help prevent complications associated with traditional fluid resuscitation volumes.
Background:
After a burn, optimal fluid resuscitation is critical for positive patient outcome. Although national guidelines advocate using resuscitation fluids of 4mL per kg body weight and percent body surface area (%BSA) for paediatric burns of >10% BSA, evidence in adults suggest that such volumes lead to over-resuscitation and related complications. Our aim was to investigate whether children managed with biosynthetic dressings (Biobrane™) and reduced fluid volumes remain well hydrated, as determined by clinical and laboratory parameters.
Methods:
At a single UK Burn Centre, children with scalds of 10-19%BSA managed with Biobrane were given 80% maintenance fluids and no formal burn resuscitation (permissive hypovolaemia [PH] group). Urine output (UO), serum sodium, urea, and creatinine were used as 24h markers of hydration and concentrations compared to those in a patient cohort treated within the same centre when traditional resuscitation was used (TR group).
Results:
Serum sodium concentrations and UO in the PH group were similar to those in the TR group (median sodium: PH=136, TR=136, P=1.00; median UO: PH=1.5, TR=1.8, P=0.25). Urea concentrations were lower and creatinine concentrations higher in the TR group compared to the PH group (median urea: PH=3.2, TR=2.3, P=0.04; median creatinine: PH=21, TR=30, P<0.001). A higher proportion of TR patients than PH patients fell outside the reference ranges for urea (61% vs. 23%; P=0.04) and creatinine (44% vs. 8%; P=0.03).
Conclusion:
Based on markers of hydration, children with moderate-sized scalds managed with Biobrane can be safely managed with less fluid.
