title: Early fluid resuscitation improves outcomes in severely burned children.
abstract: 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.
authors.affiliation: Department of Surgery, University of Texas Medical Branch and Shriners Hospital for Children, Galveston 77550, USA. rbarrow@sbi.utmb.edu
authors.forename: R E
authors.initials: RE
authors.lastname: Barrow
authors.forename: M G
authors.initials: MG
authors.lastname: Jeschke
authors.forename: D N
authors.initials: DN
authors.lastname: Herndon
mesh_terms: 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