Optimized fluid management improves outcomes of pediatric burn patients

摘要

Background: One of the major determinants for survival of severely burned patients is appropriate fluid resuscitation. At present, fluid resuscitation is calculated based on body weight or body surface area, burn size, and urinary output. However, recent evidence suggests that fluid calculation is inadequate and that over- and under-resuscitations are associated with increased morbidity and mortality. We hypothesize that optimizing fluid administration during the critical initial phase using a transcardiopulmonary thermodilution monitoring device (pulse contour cardiac output [PiCCO]; Pulsion Medical Systems, Munich, Germany) would have beneficial effects on the outcome of burned patients. Methods: A cohort of 76 severely burned pediatric patients with burns over 30% of the total body surface area who received adjusted fluid resuscitation using the PiCCO system were compared with 76 conventionally monitored patients (C). Clinical hemodynamic measurements, organ function (DENVER2 score), and biomarkers were recorded prospectively for the first 20 d after burn injury. Results: Both cohorts were similar in demographic and injury characteristics. Patients in the PiCCO group received significantly less fluids (P < 0.05) with similar urinary output, resulting in a significantly lower positive fluid balance (P < 0.05). The central venous pressure in the PiCCO group was maintained in a more controlled range (P < 0.05), associated with a significantly lower heart rate and significantly lower incidence of cardiac and renal failure (P < 0.05). Conclusions: Fluid resuscitation guided by transcardiopulmonary thermodilution during hospitalization represents an effective adjunct and is associated with beneficial effects on postburn morbidity.