Resuscitation in Extensive Burn in Pediatrics and Fluid Creep: an Update
- 7 Downloads
Purpose of review
Excessive administration of crystalloid and the abandonment of colloid replenishment at certain point of resuscitation are the major contributors to fluid overload, leading to a phenomenon termed fluid creep. Over-resuscitation in burn pediatric patients often results in fluid overload and many complications characterized by anasarca, orbital compartment syndrome, extremity compartment syndrome, bloodstream infections, pneumonia, abdominal compartment syndrome, and pulmonary edema requiring a prolonged and potentially complicated hospital stay.
Permissive hypovolemia has been shown to effectively reduce organ dysfunction, when applied a rigorous control of diuresis. More recently, a urine output target of 0.5 to 1 ml/kg/h in the first 48 h of fluid resuscitation has become a trend in the monitoring of pediatric patients. Colloids appear to be an essential component for the resuscitation of severely burned patients.
Many strategies were developed to optimize fluid resuscitation in burn patients, and until current days there are controversies regarding the most efficient method to determine the ideal volume of fluid to avoid hypovolemic shock and complications from over resuscitation as well. The success of resuscitation is related to the administration of lower fluid volumes. Some centers have demonstrated that selection of more strict protocols of fluid resuscitation, rigorous diuresis control, moderate use of opioids, and early and regular use of albumin are correlated to positive outcomes and thus may attenuate the urgence of fluid creep.
KeywordsBurns Albumin Colloids Resuscitation Pediatrics Edema
Compliance with Ethical Standards
Conflict of Interest
Maria Helena Müller Dittrich declares that she has no conflict of interest. Nicole Dittrich Hosni declares that she has no conflict of interest. Werther Brunow de Carvalho declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
- 2.Brusselaers N, Monstrey S, Vogelaers D, Hoste E, Blot S. Severe burn injury in Europe: a systematic review of the incidence, etiology, morbidity, and mortality. Crit Care BioMed Central Ltd. 2010;14(5):R188.Google Scholar
- 3.Karimi H, Motevalian A, Motabar AR, Safari R, Parvar MS, Vasigh M. Epidemiology of paediatric burns in iran. 2012;XXV(September):2–7.Google Scholar
- 5.de O ML, Santos MC, Silva GM. Resistência à Insulina em Criancas Queimadas: revisão sistemática. Rev Bras Queimaduras. 2013;12(4):245–52.Google Scholar
- 8.Smolle C, Cambiaso-daniel J, Forbes AA, Wurzer P, Hundeshagen G. Branski LK. ScienceDirect Recent trends in burn epidemiology worldwide : A systematic review. 2016:2–10.Google Scholar
- 10.Data & Statistics (WISQARS™): Cost of injury reports CDC for Disease Control and Prevention. Available from: https://www.cdc.gov/injury/wisqars/index.html.
- 12.•• Saffle JR. Fluid creep and over-resuscitation burns fluid resuscitation fluid creep colloid. Crit Care Clin. Elsevier Inc; 2016; This study reviewed the topics of overresuscitation and management of fluid creep. Colloid use in burn resuscitation is now regaining popularity. More than half the centers responding in a recent international survey of resuscitation practices now incorporate colloid within the first 24 h of injury.Google Scholar
- 27.Lund C, Browder N. The estimation of areas of burns. Surg Gym Obs. 1944;79:352–8.Google Scholar
- 42.•• Faraklas I, Lam U, Cochran A, Stoddard G, Saffle J. Colloid normalizes resuscitation ratio in pediatric burns. J Burn Care Res. 2011;32(1):91–7 This study reviewed the use of crystalloid resuscitation to crystalloid plus colloid supplementation in children with > 15% TBSA burns. They found that a subset of patients with deeper, more severe burns, and those with inhalation injuries who failed to maintain target urine output, achieved this goal with the addition of colloid.PubMedCrossRefPubMedCentralGoogle Scholar
- 45.• Arbuthnot MK, Garcia AV. Seminars in pediatric surgery early resuscitation and management of severe pediatric burns. Semin Pediatr Surg [Internet] Elsevier Inc. 2019;28(1):73–8 Outcomes following severe burn injury in children have improved with specific attention to prompt and goal-directed resuscitation. Still, the challenge remains in ensuring that providers managing pediatric burns account for the acute physiologic differences in children as they proceed with resuscitation management.CrossRefGoogle Scholar
- 49.Goodwin CW, Dorethy J, Lam V, Pruitt BA. Randomized trial of efficacy of crystalloid and colloid resuscitation on hemodynamic response and lung water following thermal injury :520–9.Google Scholar
- 51.Abston S, Blakeney P, Desai M, Heggers J, Herndon D, Hildreth M, et al. House staff manual - Total burn care [internet]. Galveston. Texas. Available from: http://www.totalburncare.com/orientation_intro.htm.