Left ventricular failure complicating severe pediatric burn injuries

Area of Science:

• Pediatric Critical Care Medicine
• Burn Injury Management
• Cardiovascular Physiology

Background:

• Failed resuscitation contributes significantly to mortality in critically burned children.
• Myocardial depression is implicated in burn shock, with varying patterns in adults and the elderly.
• Understanding cardiac dysfunction is crucial for optimizing pediatric burn resuscitation.

Purpose of the Study:

• To investigate the role of myocardial depression in failed resuscitation among critically burned children.
• To identify the specific patterns of cardiac dysfunction (left vs. right ventricular) in this population.
• To evaluate the utility of hemodynamic monitoring in guiding resuscitation strategies.

Main Methods:

• Retrospective analysis of 28 critically burned children (>60% TBSA) resuscitated between 1989-1992.
• Invasive hemodynamic monitoring, including pulmonary artery catheterization in 9 patients with failed standard therapy.
• Fluid resuscitation guided by the Parkland formula, with assessment of cardiac function via thermodilution.

Main Results:

• All patients exhibited depressed left ventricular function (average LVSWI 19.9 g.m/m2, normal 44-68).
• 38% of patients also showed concomitant right ventricular failure.
• Left ventricular dysfunction persisted but improved with vasopressors and modified fluid resuscitation.

Conclusions:

• Cardiogenic failure, predominantly left-sided myocardial depression, is a key factor in failed pediatric burn resuscitation.
• Pulmonary artery catheter data is valuable for directing vasopressor use and modifying fluid resuscitation.
• Therapeutic adjustments based on hemodynamic monitoring can improve cardiac function in pediatric burn victims.