Department of Pediatric Surgery, Penn State Hershey Children's Hospital, Penn State Milton S. Hershey Medical Center, PO Box 850, Hershey, PA 17033, USA.
J Pediatr Surg. 2011 Sep;46(9):1753-8. doi: 10.1016/j.jpedsurg.2011.04.018.
A subset of children with scald burns develops respiratory failure despite no direct injury to the lungs. We examined these patients in an effort to elucidate the etiology of the respiratory failure.
The charts of pediatric patients with greater than 10% total body surface area (TBSA) scald burns were reviewed. Age, weight, burn distribution, percentage of TBSA burned, resuscitation volumes, Injury Severity Score, evidence of abuse, length of stay, days in the intensive care unit, and time and duration of intubation were recorded.
Two hundred thirty-two patients met our inclusion criteria. Of these, 220 patients did not require intubation, and 12 of the patients did. No patient older than 3 years or with burns less than 15% TBSA required intubation. Fluid over resuscitation was not directly associated with respiratory failure requiring mechanical ventilation.
We report the largest published series of patients with scald burns requiring mechanical ventilation in the absence of direct airway injury. Five percent of pediatric patients required mechanical ventilation after scald injury. We believe that a combination of causes including fluid resuscitation, young patient age, small patient size, and possible activation of the systemic inflammatory immune response may be responsible for the respiratory failure.
尽管肺部没有直接受伤，仍有一部分烫伤患儿会发展为呼吸衰竭。我们对这些患者进行了检查，以阐明呼吸衰竭的病因。
对大于 10%总体表面积（TBSA）的烫伤患儿的病历进行了回顾。记录了年龄、体重、烧伤分布、TBSA 烧伤百分比、复苏量、损伤严重程度评分、虐待证据、住院时间、重症监护病房天数、插管时间和持续时间。
232 名患者符合我们的纳入标准。其中 220 例患者不需要插管，12 例患者需要。没有年龄大于 3 岁或 TBSA 烧伤小于 15%的患者需要插管。液体过度复苏与需要机械通气的呼吸衰竭没有直接关系。
我们报告了在没有直接气道损伤的情况下，需要机械通气的烫伤患儿中最大的已发表系列病例。5%的烫伤患儿在烫伤后需要机械通气。我们认为，包括液体复苏、患者年龄小、患者体型小以及全身炎症免疫反应激活在内的多种原因可能导致呼吸衰竭。
