Fluid Creep in Major Pediatric Burns

A systematic review on intra-abdominal pressure in severely burned patients

“…In 21 case reports and series, a mortality rate of 50% among 58 burn ACS patients was seen (2,3,5,12,16,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) (Table 4). Nine cohort studies (N=132 total) report mortality rates between 44%-100%, with a weighted average of 74.8% (18,19,(39)(40)(41)(42)(43)(44)(45) (Table 5).…”

Management and outcomes of children with severe burns in New South Wales: 1995–2013

“…Whilst the consequences of over‐resuscitation have been well established, based on resuscitation formulae, excessive fluid resuscitation was a common occurrence in our population. Unfortunately, neither urine output or the presence of haemochromogenuria and the need to increase resuscitation to prevent renal failure were recorded, and as such we could not correlate these with fluid resuscitation.…”

“…Unfortunately, neither urine output or the presence of haemochromogenuria and the need to increase resuscitation to prevent renal failure were recorded, and as such we could not correlate these with fluid resuscitation. Whilst the Modified Parkland formula remains an excellent guide to the fluid required within the first 24 h, burns clinicians advocate for the close monitoring of urine output, and haemodynamic observations, such as blood pressure and heart rate, as better means of managing fluid resuscitation once it has been established …”

Airway compromise in children with anterior neck burns: Beware the scalded child

“…It has been well established that overzealous fluid resuscitation of acute burn patients leads to significant complications such as pulmonary oedema, cerebral oedema and compartment syndromes. 2,22,23 The Modified Parkland burns resuscitation formula is used to estimate the amount of intravenous fluid required to overcome the effects of inflammatory mediators and loss of intravascular fluid volume in the first 24 h after a burn injury in those children with burns ≥10% TBSA. 2,24 In our patient population, the average amount of fluid received by these children prior to intubation was well above that recommended by the Modified Parkland formula (0.166 mL/kg/ %TBSA/h).…”