Early fluid resuscitation improves outcomes in severely burned children

• Published in: Resuscitation Vol. 45; no. 2; pp. 91 - 96
• Main Authors: Barrow, Robert E., Jeschke, Marc G., Herndon, David N.
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01-07-2000; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Burns; Burns - complications; Burns - mortality; Burns - physiopathology; Burns - therapy; Cardiac arrest; Child; Child, Preschool; Emergency and intensive care: burns; Female; Fluid resuscitation; Fluid Therapy; Heart Arrest - etiology; Heart Arrest - mortality; Humans; Infant; Infection - etiology; Intensive care medicine; Male; Medical sciences; Multi-organ failure; Outcomes; Pediatrics; Renal failure; Renal Insufficiency - etiology; Resuscitation; Retrospective Studies; Sepsis; Severity of Illness Index; Time Factors; Treatment Outcome; Pediatrics; Multi-organ failure; Cardiac arrest; Renal failure; Sepsis; Fluid resuscitation; Burns; Outcomes; Human; Burn; Prognosis; Mortality; Multiple organ failure; Complication; Early; Water electrolyte resuscitation; Severe; Trauma; Child; Resuscitation
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/S0300-9572(00)00175-1

Background: Recent evidence suggests that timely fluid resuscitation can significantly reduce multiorgan failure and mortality in thermally injured children. In this study, children who received fluid resuscitation within 2 h of a thermal injury were compared with children in which fluid resuscitation was delayed by 2–12 h. We hypothesized that fluid resuscitation given within 2 h of a thermal injury attenuates renal failure, cardiac arrest, cardiac arrest deaths, incidence of sepsis, and overall mortality.
Methods: A retrospective chart review was made on 133 children admitted to our institute from 1982 to 1999 with scald or flame burns covering more than 50% of their body surface area. Comparisons between early (<2 h of injury) or delayed (≥2 h of injury) fluid resuscitation were made in children experiencing renal failure, sepsis, non-survivors with cardiac arrest requiring pulmonary and advanced life support, and overall mortality. Comparisons were made using the
χ
2-test with Yates’ continuity correction and joint binomial confidence intervals using the Bonferroni correction.
Results: The incidence of sepsis, renal failure, non-survivors with cardiac arrest, and overall mortality was significantly higher in burned children receiving fluid resuscitation that was delayed by 2 h or more compared with those receiving fluid resuscitation within 2 h of thermal injury (
P<0.001).
Conclusions: Data suggest that fluid resuscitation, given within 2 h of a thermal injury, may be one of the most important steps in the prevention of multi-organ failure and mortality.