TREATMENT OF SEVERELY BURNED CHILDREN IN A PEDIATRIC INTENSIVE-CARE UNIT

All burn injuries involving more than 10% of the total body surfaces i n children necessitate immediate fluid replacement. Such patients shou ld be admitted to a hospital with an intensive care unit specialized i n dealing with such accidents. Fluid replacement should be started, wi th administration of an isotonic electrolyte solution, such as lactate d Ringer's, to avoid severe burn shock. Several other fluid replacemen t protocols have been proposed. Controversy exists as to whether a hyp ertonic or hypotonic solution should be used and whether or not colloi d should be added to these solutions. The findings of controlled studi es have not shown any differences with regard to morbidity or mortalit y. Dextran solution helps to stabilize the circulation during the firs t few hours. In addition, albumin should be given from 8 to 24 h post- injury. Most burned children require central venous catheters for intr avenous fluid supplementation. The adequacy of fluid replacement must be assessed by a variety of clinical parameters, beginning with urinar y excretion of above 0.5-1.0 ml/kg per hour. Acute management of burne d children includes adequate analgesia with potent drugs. Opioids or k etamine should be given to avoid pain and pain-related depression of t he circulation. Adequate intensive care of inhalation trauma, sepsis, prevention of multi-organ failure, early enteral feeding and limited p rophylactic use of antibiotics can reduce mortality in these severely ill children.