Exchange transfusion therapy in pediatric burn shock.

Irreversible burn shock, which persists despite fluid resuscitation, remains a significant cause of early mortality in thermally injured children. Since circulating serum factors have been implicated in the pathophysiology of burn shock, the use of exchange transfusion therapy was analyzed retrospectively in children filing to respond to conventional volume therapy during burn shock. Seven children with a mean burn size of 42.9% and a mean age of 3.2 years underwent exchange transfusion for ongoing burn shock after standard resuscitation failed. A therapeutic response was documented in all patients, characterized by a sharp decrease in fluid requirements from a mean of 332% of the predicted hourly volume to calculated requirements by 2.9 hr following exchange. Markedly improved urine output and resolution of lactic acidosis were also demonstrated. All patients recovered from shock with one late mortality. Exchange transfusion therapy facilitates resuscitation from burn shock in children who do not respond to conventional volume therapy.