Acute respiratory failure that complicates the resuscitation of pediatric patients with scald injuries

Respiratory failure that requires endotracheal intubation is an uncommon bu t potentially fatal complication of scald burns in children. Because scalds are rarely associated with a direct pulmonary injury, the pathophysiology of respiratory failure is unclear A possible mechanism may be upper airway edema, diminished pulmonary compliance secondary to fluid resuscitation, or both. To identify an at-risk population for intubation after a scald injur y, the hospital courses of 174 consecutive patients under the age of 14 yea rs who were admitted after a scald injury to a single burn center during a 6-year period were examined. Seven of these patients (4%) required endotrac heal intubation. No patient older than 2.8 years or who had a scald injury that covered less than 19% of the total body surface area required intubati on. Patients who required intubation were younger (mean age, 1.4 vs 2.8 yea rs, P < .001), had a larger mean burn size (29.9% vs. 12.3% total body surf ace area, P < .001), and required more fluid resuscitation (7.66 vs. 4.07 c c/kg per percentage of total body surface area burned, P < .001) than patie nts who did not require intubation. Examination of the adequacy of resuscit ation revealed that the intubated patients had an average hourly urine outp ut of 0.84 cc/kg during the first 24 hours, suggesting that resuscitation w as not excessive. Multivariate analysis demonstrated that both larger burn size (P = .041) and younger age (P = .049) were independent predictors of t he need for intubation. Young patients with large body surface area burns t hat required large volumes of resuscitation comprise an at-risk group for r espiratory failure after a scald injury. Increased vigilance is merited dur ing the resuscitation of these patients.