The Impact of Albumin in Pediatric Burn Resuscitation

Pediatric patients with larger TBSA burns have a high surface area to volume ratio and are at risk of over-resuscitation. In 2015, our burn center revised our resuscitation algorithm for "difficult to resuscitate" patients with >15% TBSA burn to substitute albumin for a portion of crystalloid volume, hoping to reduce negative effects of volume overload while preserving resuscitation goals. We retrospectively reviewed patients <18 years of age treated between 2008 and 2024 who required burn resuscitation. Patients who had ≥15% TBSA burn and required >40% of baseline fluids in the first 24 h were defined as "difficult to resuscitate." Patients who died in <48 h were excluded. Patient demographics, burn characteristics, treatment details, and patient outcomes were collected. Patients were compared using Fisher's exact and Wilcoxon rank sum tests. Thirty-four patients were "difficult to resuscitate," with 8 patients admitted prior to substitution of albumin and 26 patients treated after. Demographic characteristics did not vary between groups. Patients in the albumin group received less total intravenous fluid volume within 48 h (12.4 [IQR: 8.6-13.8] vs 7.8 [IQR 6.3-9.3] mL/kg/TBSA P = .037) and had lower serum lactate at 48 h (1.7 [IQR 1.7-2.2] vs 1.0 [IQR 0.8-1.3] mmol/L P = .018). Length-of-hospital-stay normalized to TBSA burn was shorter among those who received albumin (1.2 [IQR: 0.8-1.6] vs 1.9 [IQR:1.3-2.4] days P = .027). The substitution of albumin for pediatric burn patients who are difficult to resuscitate reduced total intravenous volume and length-of-stay per TBSA, while preserving chemical markers of adequate resuscitation.