title: Acute respiratory failure that complicates the resuscitation of pediatric patients with scald injuries.
abstract: 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.
authors.affiliation: US Army Institute of Surgical Research, Fort Sam Houston, Texas 78234, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Zak
authors.forename: D T
authors.initials: DT
authors.lastname: Harrington
authors.forename: D J
authors.initials: DJ
authors.lastname: Barillo
authors.forename: D F
authors.initials: DF
authors.lastname: Lawlor
authors.forename: K Z
authors.initials: KZ
authors.lastname: Shirani
authors.forename: C W
authors.initials: CW
authors.lastname: Goodwin
mesh_terms: D000293:Adolescent; D001830:Body Surface Area; D002056:Burns / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D012151:Resuscitation; D012189:Retrospective Studies; D012307:Risk Factors