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Resuscitation in Extensive Burn in Pediatrics and Fluid Creep: an Update

  • Pediatrics in South America (L Landry and WB de Carvalho, Section Editors)
  • Published:
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Abstract

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.

Recent findings

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.

Summary

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.

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Authors and Affiliations

  1. Federal University of São Paulo (UNIFESP), São Paulo, Brazil

    Maria Helena Müller Dittrich MD, PhD & Nicole Dittrich Hosni

  2. Pediatrics Department – USP, São Paulo, SP, Brazil

    Werther Brunow de Carvalho MD, PhD, FCCM

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  1. Maria Helena Müller Dittrich MD, PhD
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  3. Werther Brunow de Carvalho MD, PhD, FCCM
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Correspondence to Werther Brunow de Carvalho MD, PhD, FCCM.

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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.

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Dittrich, M.H.M., Hosni, N.D. & de Carvalho, W.B. Resuscitation in Extensive Burn in Pediatrics and Fluid Creep: an Update. Curr Treat Options Peds 5, 448–457 (2019). https://doi.org/10.1007/s40746-019-00182-3

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