Burn-Induced Cardiac Dysfunction Increases Length of Stay in Pediatric Burn Patients

Abstract

Objective The aim of this study was to evaluate cardiac function and clinical outcomes in perioperative pediatric burn patients. Methods Transesophageal echocardiography data was collected on 40 patients from 2004-2007. Of the 40 patients who received exams, a complete set of cardiac parameters and outcome variables was obtained in 26 patients. The mean age of the patients was 9.7 ± 0.9 years old, and the mean total body surface area burn size was 64% ± 3%. Patients were divided into two groups based on systolic function. One group represented patients with ejection fractions of >50% and the other group ejection fractions of ≤50%. Clinical variables were then compared among the groups. Results In our cohort, systolic dysfunction was observed in 62% of patients (EF ≤50%). Systolic dysfunction was associated with a statistically significant increase in number of surgeries, ventilator days and length of stay in the intensive care unit. The length of stay in patients with preserved systolic function and those with systolic dysfunction was 34.3 ±3.3 days and 67.2 ± 4.0 days respectfully. Diastolic function measurements were obtained in 65% and 88% had evidence of diastolic dysfunction. Diastolic dysfunction was not associated with any statistically significant correlations. Conclusions This study lends evidence to the well-supported basic science models showing cardiac dysfunction following burns. Additionally, it shows that cardiac dysfunction can have clinical consequences. To our knowledge this is the first study that shows the clinical sequelae of systolic dysfunction in the perioperative pediatric burn population.

Transpulmonary Thermodilution Versus Transthoracic Echocardiography for Cardiac Output Measurements in Severely Burned Children

“…This may be due to lack of experience by the user and morphological differences in the studied population. Indeed, this study was limited by the fact that the ultrasound instrument that was not of the highest quality and we relied upon trained ultrasonographers to perform and interpret exams without experienced oversight, as has been done in other studies (21). An additional limitation was that we could view only a single cardiac cycle measured by a 2D picture; this did not provide an ideal image.…”

“…An additional limitation was that we could view only a single cardiac cycle measured by a 2D picture; this did not provide an ideal image. Typically, three cardiac cycles are used and averaged to determine EDV and ESV measurements and calculate CO. Because monitoring hemodynamic status is crucial to detecting early burn-associated cardiac heart failure (8,21,23,24), a subjective method such as TTE may not be suitable for assessing myocardial function.…”

“…Several studies have shown that echocardiography is a reliable noninvasive method that can be used to guide resuscitation efforts and assess cardiac function in critically ill burn patients (15,19–21). Echocardiography is becoming a standard-of-care in many intensive care centers, and more clinicians are learning how to perform this technique and interpret echocardiographic images.…”

Cardiovascular Dysfunction Following Burn Injury: What We Have Learned from Rat and Mouse Models

“…Branski and colleagues confirmed the timing of the ebb and flow phases and increased cardiac output with elevated heart rate in pediatric burn patients via transpulmonary thermodilution monitoring device (PiCCO) [ 11 ]. Half of pediatric burn patients developed systolic dysfunction, which correlated with longer hospital stays and more surgical interventions [ 12 ]. Furthermore, in infants sustaining large burn injuries, right heart failure was the most common cause of death [ 13 ].…”

IL-15 Superagonist Expands mCD8+ T, NK and NKT Cells after Burn Injury but Fails to Improve Outcome during Burn Wound Infection

“…Furthermore, sepsis induced multi-organ injury significantly contributes to increased morbidity and mortality [ 10 – 12 ]. When combined with infection, the physiologic disturbances caused by burn injury often lead to multiorgan failure, and death [ 13 – 16 ]. In fact, infection is the most common cause of death in burn victims that survive the initial burn trauma and is a major cause of prolonged hospitalization.…”