Early fluid resuscitation improves outcomes in severely burned children.
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 (> or = 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 chi2-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.
Barrow
R E
RE
Department of Surgery, University of Texas Medical Branch and Shriners Hospital for Children, Galveston 77550, USA. rbarrow@sbi.utmb.edu
Jeschke
M G
MG
Herndon
D N
DN
D002056:Burns / Q000150:complications / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005440:Fluid Therapy; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality; D006801:Humans; D007223:Infant; D007239:Infections / Q000209:etiology; D008297:Male; D051437:Renal Insufficiency / Q000209:etiology; D012151:Resuscitation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome