Acute respiratory failure that complicates the resuscitation of pediatric patients with scald injuries

• Published in: Journal of burn care & rehabilitation Vol. 20; no. 5; p. 391
• Main Authors: Zak, A L, Harrington, D T, Barillo, D J, Lawlor, D F, Shirani, K Z, Goodwin, C W
• Format: Journal Article
• Language: English
• Published: United States 01-09-1999
• Subjects: Adolescent; Body Surface Area; Burns - complications; Child; Child, Preschool; Female; Fluid Therapy; Humans; Intubation, Intratracheal; Male; Respiratory Insufficiency - epidemiology; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; Resuscitation; Retrospective Studies; Risk Factors
• ISSN: 0273-8481
• DOI: 10.1097/00004630-199909000-00011

Respiratory failure that requires endotracheal intubation is an uncommon but potentially fatal complication of scald burns in children. Because scalds are rarely associated with a direct pulmonary injury, the pathophysiology of respiratory failure is unclear. A possible mechanism may be upper airway edema, diminished pulmonary compliance secondary to fluid resuscitation, or both. To identify an at-risk population for intubation after a scald injury, the hospital courses of 174 consecutive patients under the age of 14 years who were admitted after a scald injury to a single burn center during a 6-year period were examined. Seven of these patients (4%) required endotracheal intubation. No patient older than 2.8 years or who had a scald injury that covered less than 19% of the total body surface area required intubation. Patients who required intubation were younger (mean age, 1.4 vs. 2.8 years, P<.001), had a larger mean burn size (29.9% vs. 12.3% total body surface area, P<.001), and required more fluid resuscitation (7.66 vs. 4.07 cc/kg per percentage of total body surface area burned, P<.001) than patients who did not require intubation. Examination of the adequacy of resuscitation revealed that the intubated patients had an average hourly urine output of 0.84 cc/kg during the first 24 hours, suggesting that resuscitation was not excessive. Multivariate analysis demonstrated that both larger burn size (P = .041) and younger age (P = .049) were independent predictors of the need for intubation. Young patients with large body surface area burns that required large volumes of resuscitation comprise an at-risk group for respiratory failure after a scald injury. Increased vigilance is merited during the resuscitation of these patients.