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Crystalloids, colloids and kids: a review of paediatric burns in intensive care
A J Cocks1, A O'Connell, H Martin
1Emergency Department, The Royal Alexandra Hospital for Children, Parramatta, NSW 2124, Australia. amandac@nch.edu.au
Insights
Pediatric intensive care unit (PICU) fluid resuscitation for burns shock requires careful monitoring. The hospital
Area of Science:
- Pediatric intensive care
- Burn resuscitation
- Critical care medicine
Background:
- Burns are a significant cause of pediatric intensive care unit (PICU) admissions.
- Fluid resuscitation is critical for managing burn shock, but optimal strategies remain debated.
- Previous research indicates variability in fluid resuscitation protocols for pediatric burn patients.
Purpose of the Study:
- To review fluid resuscitation therapy and clinical outcomes for pediatric burn patients.
- To evaluate the effectiveness of different resuscitation formulas in a PICU setting.
- To identify factors influencing mortality and adverse events in pediatric burn care.
Main Methods:
- Retrospective review of pediatric burn patients admitted to a PICU over seven years.
- Analysis of resuscitation fluid therapy, clinical course, and patient demographics.
- Comparison of outcomes between patients receiving different resuscitation regimens.
Main Results:
- Ninety-eight burn patients were admitted, with a 10.2% mortality rate, primarily in severe burns (>25% BSA).
- Acute Respiratory Distress Syndrome (ARDS) occurred in 20% of patients, with an 18% mortality rate.
- The hospital-recommended formula underestimated fluid needs; no significant difference in adverse effects was noted between groups.
Conclusions:
- The hospital-recommended resuscitation formula was inadequate for pediatric burn shock.
- Meticulous fluid resuscitation guided by clinical effect is recommended over a definitive formula.
- Further research is needed to establish optimal fluid resuscitation strategies for pediatric burns.
Abstract:
This is a retrospective review of all burns patients admitted to a paediatric intensive care unit (PICU) over a 7 year period. Resuscitation fluid therapy and clinical course are presented. Ninety-eight new burns victims were admitted with a mortality rate of 10.2%, all in burns of greater than 25% body surface area (BSA). The incidence of ARDS was 20%, with an 18% mortality rate. Of 85 patients with burns greater than 5% BSA, 33 received the hospital-recommended colloid-based resuscitation formula, 46 received a combination of crystalloids and colloids and in 6 patients the resuscitation regimen was not able to be determined. The aetiology, age distribution, sex ratio, severity of burns and length of stay in hospital did not alter significantly over the study period. The number of burns admissions to PICU increased, as did their duration of intubation and ICU stay. The hospital-recommended resuscitation formula consistently underestimated the fluid volume required for adequate resuscitation. No statistically significant difference in adverse effects was found between the resuscitation groups. This study is unable to recommend a definitive approach to the fluid resuscitation of burns shock in paediatrics and the best approach is one of meticulous fluid resuscitation titrated on clinical effect.