title: The volume limit in fluid resuscitation to prevent respiratory failure in massively burned children without inhalation injury.
abstract: We evaluated the accurate fluid requirement to prevent respiratory failure during the postresuscitation period in the resuscitation of massively burned children without inhalation injury. Forty-nine children were treated by similar fluid resuscitation and physiologic support protocols. Using a retrospective chart review, the children were divided into three groups as follows: Group N (no lung injury, n = 33, 41.4+/-18.7%TBSA burned), Group M (mild-to-moderate lung injury, n = 11, 73.7+/-17.1%TBSA burned) and Group S (severe lung injury, n = 5, 67.2+/-16.6%TBSA burned). Information about fluid resuscitation during the first 24 hr post-injury was collected and compared among the three groups. There was no significant difference in the hourly urine output and the resuscitation volume estimated by body weight and burn size among the groups. The volumes estimated by ml/kg/%TBSA burned were 7.0 ml/kg/%TBSA burned, 8.0 ml/kg/%TBSA burned, and 9.4 ml/kg/%TBSA burned in Groups N, M, and S, respectively. According to the fluid volume estimated by the burn index (BI; 1/2 of % second-degree burns plus % third-degree burns), the volumes were 13.8+/-4.0 ml/kg/BI, 14.4+/-4.4 ml/kg/BI, 18.8+/-3.7ml/kg/BI in Groups N, M, and S, respectively (Group N < Group S, p < 0.05). There was a significant positive correlation between the maximum respiratory index (AaDO2/PaO2) during the first week and the initial total volume administered (ml/kg/BI). These findings indicated that the fluid requirements to prevent postresuscitation respiratory failure in massively burned children might be estimated according to the depth of burned area in addition to body weight and burn size.
authors.affiliation: The Department of Emergency and Critical Care Medicine, Hiroshima University School of Medicine, Japan. okiyoshi@hiroshima-u.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Okabayashi
authors.forename: M
authors.initials: M
authors.lastname: Ohtani
authors.forename: T
authors.initials: T
authors.lastname: Yamanoue
authors.forename: A
authors.initials: A
authors.lastname: Sera
authors.forename: S
authors.initials: S
authors.lastname: Wada
authors.forename: T
authors.initials: T
authors.lastname: Inoue
authors.forename: Y
authors.initials: Y
authors.lastname: Iwasaki
mesh_terms: D001798:Blood Proteins / Q000378:metabolism; D002056:Burns / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004231:Diuresis; D005440:Fluid Therapy; D006801:Humans; D055370:Lung Injury; D012044:Regression Analysis; D012131:Respiratory Insufficiency / Q000209:etiology / Q000517:prevention & control*; D012151:Resuscitation; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D013997:Time Factors; D014882:Water-Electrolyte Balance
chemical_list: D001798:Blood Proteins; D012709:Serum Albumin