Fluid resuscitation in thermally injured children.

The fluid resuscitation requirements and mortality from thermal injury were reviewed in 177 children admitted to the Intermountain Burn Center over a 7 year period. Mean burn size was 27 percent of the total body surface area, whereas the mean full-thickness burn size was 13 percent of total body surface area. Twelve percent of children had associated inhalation injuries. The mean amount of fluid received during burn shock resuscitation was 5.8 +/- 0.25 ml/kg per percentage of total body surface area burned and the mean amount of sodium, 1.06 +/- 0.04 mEq/kg per percentage of total body surface area burned. There was no morbidity due to fluid overload. The presence of inhalation injury did not increase fluid or sodium requirements, but did increase mortality (29 percent versus 7 percent, p less than 0.05). The resuscitative mortality rate for all pediatric patients was 7 percent, the in-hospital mortality rate was 15 percent, and the 50 percent mortality burn correlate for these patients was 64 percent of the total body surface area. Data on children with burns were compared with an unselected, concurrent group of adult burn patients using an analysis of covariance. Fluid and sodium requirements were significantly higher for children, but there was no difference in the length of resuscitation or mortality rate. We conclude that children require much more fluid for resuscitation from burn shock than adults with similar burns. Appropriately aggressive fluid therapy for acute thermal injury in children is essential to achieve an acceptable survival rate in these patients.