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Fluid resuscitation in thermally injured pediatric patients
Z Marinov1, K Kvalténi, J Koller
1Burn Center, General Hospital Ruzinov, Bratislava, Slovakia.
Insights
Pediatric burn resuscitation requires precise fluid therapy. While 4 ml/kg/% body surface area burn (BSAB) formulas replace theoretical losses, 2 ml/kg/% BSAB offers a more practical guideline for treating pediatric burn shock.
Area of Science:
- Pediatric critical care
- Burn management
- Resuscitation science
Background:
- Children represent a significant portion of critical burn cases, posing unique resuscitation challenges due to limited physiological reserve.
- Pediatric fluid replacement therapy necessitates precise calculations, differentiating between physiological and pathological fluid losses.
Purpose of the Study:
- To review and compare widely accepted pediatric isotonic fluid resuscitation protocols.
- To evaluate the efficacy of 2 ml/kg/% body surface area burn (BSAB) and 4 ml/kg/% BSAB formulas in pediatric burn patients.
Main Methods:
- Reviewed established pediatric isotonic fluid protocols, specifically focusing on formulas from Cincinnati and Galveston Shriner's Burns Institutes.
- Calculated fluid therapy requirements for model pediatric burn patients (10 kg, 30 kg) with varying burn severities (20% to 80% BSAB).
- Compared calculated fluid volumes with physiological parameters relevant to pediatric burn patients.
Main Results:
- Both 4 ml/kg/% BSAB formulas adequately replace theoretically predicted pathophysiological losses.
- Calculations indicated that 2 ml/kg/% BSAB formulas provide a more practical guideline for resuscitation.
- The 2 ml/kg/% BSAB approach demonstrated a greater therapeutic range and better clinical response in children experiencing burn shock.
Conclusions:
- The 2 ml/kg/% BSAB fluid resuscitation formulas are more practical for pediatric burn patients, offering a wider therapeutic margin.
- All fluid therapy formulas serve as guidelines and require modification based on individual patient needs and clinical status.
- Successful fluid resuscitation is crucial for maintaining perfusion, optimizing oxygenation, promoting healing, and preparing burn areas for grafting.
Abstract:
More than two-thirds of critical burns in special burn units are children. The burned child continues to represent a special challenge, since resuscitation therapy must be more precise than that for an adult with a similar burn. Children have a limited physiologic reserve and the pediatric fluid replacement therapy is based on the principle of separate calculation of physiological and pathological losses. We have reviewed the most widely accepted pediatric isotonic fluid protocols. All these protocols calculate for replacement of pathological losses with a need of 2 ml/kg/% BSAB (body surface area burn) or 4 ml/kg/% BSAB. We choosed the formulas of two Shriner's Burns Institutes--the Cincinnati and the Galveston Unit as representatives, and calculated the fluid therapy for model burn children weights of 10 kg, 30 kg with 20, 40, 60, 80% BSAB. The results of calculations where compared with physiologic parameters of children. In conclusions we could show, that the 4 ml/kg/% BSAB formulas do replace all theoretically predicted pathophysiologic losses due to burns. However, the 2 ml/kg/% BSAB formulas are more practical as a guideline for resuscitation of pediatric patients because of greater therapeutical range and better clinical response of children threatened by burn shock. It is important to remember that all formulas are only guides to fluid therapy, they should be modified according to individual needs and clinical status of the patient. Only successful restoring and maintaining perfusion pressures leads to optimal oxygenation of injured and noninjured tissues, which promotes spontaneous healing, prevents wound conversion, minimise bacterial colonisation, and prepares the injured areas for early grafting.