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[Therapy of the severely burned child from the pediatric intensive care viewpoint]
1Kinderkrankenhaus Wilhelmstift, Hamburg.
Insights
Immediate fluid replacement is crucial for children with extensive burn injuries (>10% body surface). Optimal management involves specialized intensive care, isotonic solutions, and careful monitoring to prevent burn shock and improve outcomes.
Area of Science:
- Pediatric Burn Management
- Critical Care Medicine
- Trauma Surgery
Context:
- Extensive burn injuries in children (>10% total body surface area) require immediate and specialized medical intervention.
- Effective fluid resuscitation is paramount to prevent severe burn shock and associated complications.
- Current fluid replacement protocols involve isotonic solutions, with ongoing debate regarding hypertonic/hypotonic solutions and colloid administration.
Purpose:
- To outline essential management strategies for pediatric burn patients requiring intensive care.
- To emphasize the critical role of immediate fluid replacement in preventing burn shock.
- To discuss current controversies and evidence regarding fluid resuscitation protocols in severe pediatric burns.
Summary:
- Immediate fluid replacement with isotonic electrolyte solutions (e.g., lactated Ringer's) is vital for pediatric burn victims with >10% body surface area involvement.
- While controlled studies show no significant differences in morbidity or mortality between various fluid protocols, early administration of dextran and albumin may be beneficial.
- Adequate analgesia, central venous catheterization for fluid delivery, and monitoring of urinary output (0.5-1.0 ml/kg/hr) are key components of care.
- Comprehensive intensive care, including management of inhalation trauma, sepsis, organ failure prevention, early enteral feeding, and judicious antibiotic use, is essential for reducing mortality.
Impact:
- Establishes critical care guidelines for severe pediatric burns, focusing on fluid resuscitation and early management.
- Highlights the importance of specialized pediatric intensive care units for optimal patient outcomes.
- Provides a framework for addressing ongoing controversies in fluid management, guiding future research and clinical practice.
Abstract:
All burn injuries involving more than 10% of the total body surfaces in children necessitate immediate fluid replacement. Such patients should be admitted to a hospital with an intensive care unit specialized in dealing with such accidents. Fluid replacement should be started, with administration of an isotonic electrolyte solution, such as lactated Ringer's, to avoid severe burn shock. Several other fluid replacement protocols have been proposed. Controversy exists as to whether a hypertonic or hypotonic solution should be used and whether or not colloid should be added to these solutions. The findings of controlled studies have not shown any differences with regard to morbidity or mortality. Dextran solution helps to stabilize the circulation during the first few hours. In addition, albumin should be given from 8 to 24 h post-injury. Most burned children require central venous catheters for intravenous fluid supplementation. The adequacy of fluid replacement must be assessed by a variety of clinical parameters, beginning with urinary excretion of above 0.5-1.0 ml/kg per hour. Acute management of burned children includes adequate analgesia with potent drugs. Opioids or ketamine should be given to avoid pain and pain-related depression of the circulation. Adequate intensive care of inhalation trauma, sepsis, prevention of multi-organ failure, early enteral feeding and limited prophylactic use of antibiotics can reduce mortality in these severely ill children.