Early fluid resuscitation improves outcomes in severely burned children

Background: Recent evidence suggests that timely fluid resuscitation can si gnificantly reduce multiorgan failure and mortality in thermally injured ch ildren. In this study, children who received fluid resuscitation within 2 h of a thermal injury were compared with children in which fluid resuscitati on was delayed by 2-12 h. We hypothesized that fluid resuscitation given wi thin 2 h of a thermal injury attenuates renal failure, cardiac arrest, card iac arrest deaths, incidence of sepsis, and overall mortality. Methods: A r etrospective chart review was made on 133 children admitted to our institut e from 1982 to 1999 with scald or flame burns covering more than 50% of the ir body surface area. Comparisons between early (< 2 h of injury) or delaye d (greater than or equal to 2 h of injury) fluid resuscitation were made in children experiencing renal failure, sepsis, non-survivors with cardiac ar rest requiring pulmonary and advanced life support, and overall mortality. Comparisons were made using the chi(2)-test with Yates' continuity correcti on and joint binomial confidence intervals using the Bonferroni correction. Results: The incidence of sepsis, renal failure, non-survivors with cardia c arrest, and overall mortality was significantly higher in burned children receiving fluid resuscitation that was delayed by 2 h or more compared wit h those receiving fluid resuscitation within 2 h of thermal injury (P < 0.0 01). Conclusions: Data suggest that fluid resuscitation, given within 2 h o f a thermal injury, may be one of the most important steps in the preventio n of multi-organ failure and mortality. (C) 2000 Elsevier Science Ireland L td. All rights reserved.