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Fluid resuscitation of infants and children with massive thermal injury
T A Graves1, W G Cioffi, W F McManus
1U. S. Army Institute of Surgical Research, Fort Sam, Houston, Texas.
Insights
For pediatric burn patients under 25kg, a standardized fluid resuscitation of 3 cc/kg/% total body surface burned (TBSB) is recommended. This approach ensures adequate intravenous fluid resuscitation for young children with severe burns.
Area of Science:
- Pediatric Surgery
- Burn Management
- Critical Care Medicine
Background:
- Pediatric burn patients have limited physiologic reserve, making precise fluid resuscitation crucial.
- Accurate fluid volume calculations are essential for optimal outcomes in pediatric burn care.
Purpose of the Study:
- To quantify the intravenous fluid requirements for pediatric burn patients.
- To determine the influence of patient factors on fluid resuscitation volumes in children.
Main Methods:
- Retrospective review of medical records for 43 pediatric patients (weight ≤25 kg, burn size ≥25% TBSB) admitted between 1980-1986.
- Analysis of fluid volumes administered and calculation of net resuscitation fluid (total volume minus maintenance).
- Univariate analysis and linear regression to assess the impact of age, weight, burn depth, and inhalation injury.
Main Results:
- The average total fluid volume administered was 6.3 cc/kg/% TBSB.
- The average net resuscitation fluid volume was 3.91 cc/kg/% TBSB.
- Age, weight, burn depth, and inhalation injury did not significantly affect resuscitation volume.
Conclusions:
- A recommended starting point for burn resuscitation in pediatric patients is 3 cc/kg/% TBSB, in addition to maintenance fluids.
- This standardized approach simplifies fluid management in critically burned children.
- Further research may refine fluid management strategies based on specific pediatric burn characteristics.
Abstract:
Age-related limitations of physiologic reserve in burned children make adequacy of intravenous fluid resuscitation critical. To quantify fluid requirements, the medical records of all children admitted to the Army Institute of Surgical Research from 1980 to 1986 whose weight was 25 kilograms or less and burn size was 25% or greater were reviewed to quantify fluid requirements. Forty-three children ranging in age from 1.5-108 months (means 26 +/- 22 m), with 25-89% total body surface burned (TBSB) (means 41.7% +/- 14.6%), met inclusion criteria. The average total volume of fluid received during the first 24 hours was 6.3 +/- 2.2 cc/kg/% TBSB. The net volume of resuscitation fluid, total volume less the calculated maintenance fluid requirements, was 3.91 +/- 2.2 cc/kg/% TBSB. Univariate analysis and linear regression of independent variables including age, weight, per cent full thickness, and inhalation injury revealed each had no significant influence on the volume of resuscitation. We recommend supplying maintenance volume and initiating burn resuscitation at 3 cc/kg/% TBSB.