Nagpal Ashish, Clingenpeel Melissa-Moore, Thakkar Rajan K, Fabia Renata, Lutmer Jeffrey
Department of Pediatrics, Division of Critical Care Medicine, The Children's Hospital at OU Medical Center, 1200 Children's Ave, Oklahoma City, OK, 73104, United States.
Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43215, United States; Biostatistics Core, The Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, United States.
Burns. 2018 Aug;44(5):1308-1316. doi: 10.1016/j.burns.2018.01.018. Epub 2018 Mar 7.
To determine the association between fluid resuscitation volume following pediatric burn injury and impact on outcomes.
A retrospective chart review of pediatric patients (0-18 years) sustaining ≥15% TBSA burn, admitted to an American Burn Association verified pediatric burn center from 2010 to 2015.
Twenty-seven patients met inclusion criteria and had complete data available for analysis. Fifteen (56%) patients received greater than 6ml/kg/total body surface area burn in first 24h and twelve (44%) patients received less than 6ml/kg/percent total body surface area burn in first 24h. There were no differences between groups in median number of mechanical ventilator days (4 vs 8, p=0.96), intensive care unit length of stay (10 vs 13.5, p=0.75), or hospital length of stay (37 vs 37.5, p=0.56). Secondary analysis revealed that patients with a higher mean cumulative fluid overload (>253ml/kg, n=16) had larger burn size, higher injury severity scores, and were more likely to receive mechanical ventilation and invasive support devices. Controlling for burn size, odds of longer PICU length of stay and duration of mechanical ventilation were 20.33 [95% CI (1.7-235.6) p=0.02] and 27.9 [95% CI (2.1-364.7) p=0.01], respectively, among patients with a high cumulative fluid overload on day 3 compared to low cumulative fluid overload.
Resuscitation volume in the first 24h was not associated with adverse outcomes. Persistent cumulative fluid overload at day 3 and beyond was independently associated with adverse outcomes.
确定小儿烧伤后液体复苏量与预后影响之间的关联。
对2010年至2015年入住美国烧伤协会认证的小儿烧伤中心、烧伤总面积≥15%的0至18岁小儿患者进行回顾性病历审查。
27例患者符合纳入标准且有完整数据可供分析。15例（56%）患者在最初24小时内接受的液体量超过6毫升/千克/烧伤总面积，12例（44%）患者在最初24小时内接受的液体量少于6毫升/千克/烧伤总面积百分比。两组在机械通气天数中位数（4天对8天，p = 0.96）、重症监护病房住院时间（10天对13.5天，p = 0.75）或住院时间（37天对37.5天，p = 0.56）方面无差异。二次分析显示，平均累积液体超负荷较高（>253毫升/千克，n = 16）的患者烧伤面积更大、损伤严重程度评分更高，且更有可能接受机械通气和侵入性支持设备。在控制烧伤面积后，与低累积液体超负荷的患者相比，第3天累积液体超负荷高的患者入住儿科重症监护病房时间延长和机械通气持续时间的比值比分别为20.33 [95%置信区间（1.7 - 235.6），p = 0.02]和27.9 [95%置信区间（2.1 - 364.7），p = 0.01]。
最初24小时的复苏量与不良预后无关。第3天及以后持续的累积液体超负荷与不良预后独立相关。
