Optimized fluid management in pediatric burn patients by transthoracic echocardiography

Accurate assessment of intravascular volume status is crucial for managing fluid resuscitation in pediatric burn patients. Conventional methods, such as clinical signs and urine output, may be insufficient. This study aimed to evaluate the effectiveness of transthoracic echocardiography (TTE) in guiding fluid therapy for severely burned children.

This retrospective study included 40 pediatric patients with burns covering ≥ 20 % of total body surface area (TBSA), admitted within 24 h of injury to the pediatric burn center between 2019 and 2022. Patients were divided into two groups: TTE group (n = 20) and control group (n = 20). The TTE group received fluid therapy guided by TTE parameters, particularly the inferior vena cava to aorta (IVC/Ao) ratio. The control group was managed using conventional methods. Demographic data, clinical characteristics, fluid management, and outcomes were compared between the groups.

There were no significant differences in age, gender, TBSA burned, or burn type between groups. In the TTE group, fluid therapy was modified in 80 % of patients based on echocardiographic findings. The TTE group required less diuretic treatment (10 % vs 60 %, p < 0.05) compared to the control group. Although the TTE group had higher rates of initial intubation (55 % vs 20 %, p < 0.05) and inotropic support (35 % vs 5 %, p < 0.05), there was no significant difference in mortality between groups. A negative, moderate linear relationship was found between urine output and descending aorta diameter in the TTE group (correlation coefficient: -0.47, p = 0.04).

The addition of TTE to conventional methods for managing fluid resuscitation in pediatric burn patients may help reduce unnecessary fluid administration and diuretic use. TTE, particularly the IVC/Ao ratio, appears to be a valuable tool for assessing intravascular volume status in this population. While further prospective studies are needed to establish standardized reference values for TTE parameters in pediatric burn patients, this non-invasive method shows promise in improving fluid management and potentially reducing complications associated with over- or under-resuscitation.