Pediatric burn resuscitation, management, and recovery for the pediatric anesthesiologist

Background Burn resuscitation, including titration of fluids and administration of colloids, is often driven by physicians’ orders. Inconsistencies in burn resuscitation cause overresuscitation, which has adverse consequences. Methods Retrospective chart reviews were completed to evaluate fluid resuscitation and complications for 12 months before and after development and implementation of a nurse-driven burn resuscitation protocol. Results Before implementation of the protocol, results at 24 hours after injury indicated that 58% of patients were overresuscitated, had a serum level of lactate of at least 2 mmol/L (100%), and had complications (pulmonary edema 20%, abdominal compartment syndrome 7%, acute lung injury/acute respiratory distress syndrome 30%) within the first 5 days. Two outcomes differed from before to after implementation of the protocol: serum level of lactate at 24 hours (t37.8 =2.38, P =.007) and central venous pressure at 48 hours (t31 =2.27, P =.03). After implementation of the protocol, no patients had abdominal compartment syndrome develop. Conclusions Implementation of the nurse-driven burn resuscitation protocol improved nurses’ awareness and assessment of fluid status during resuscitation and improved patients’ outcomes.

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A randomized prospective comparison of the Baxter and Modified Brooke formulas for acute burn resuscitation

Burns Open ◽

10.1016/j.burnso.2021.03.003 ◽

2021 ◽

Vol 5 (3) ◽

pp. 89-95

Author(s):

Daizoh Saitoh ◽

Satoshi Gando ◽

Kunihiko Maekawa ◽

Junichi Sasaki ◽

Seitaro Fujishima ◽

...

Keyword(s):

Prospective Comparison ◽

Burn Resuscitation

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A History of Fluid Management—From “One Size Fits All” to an Individualized Fluid Therapy in Burn Resuscitation

Medicina ◽

10.3390/medicina57020187 ◽

2021 ◽

Vol 57 (2) ◽

pp. 187

Author(s):

Dorothee Boehm ◽

Henrik Menke

Keyword(s):

Fluid Therapy ◽

Point Of Care ◽

Fluid Management ◽

Point Of Care Ultrasound ◽

Burn Patients ◽

Starting Point ◽

History Of ◽

Definition Of ◽

Historical Developments ◽

Burn Resuscitation

Fluid management is a cornerstone in the treatment of burns and, thus, many different formulas were tested for their ability to match the fluid requirements for an adequate resuscitation. Thereof, the Parkland-Baxter formula, first introduced in 1968, is still widely used since then. Though using nearly the same formula to start off, the definition of normovolemia and how to determine the volume status of burn patients has changed dramatically over years. In first instance, the invention of the transpulmonary thermodilution (TTD) enabled an early goal directed fluid therapy with acceptable invasiveness. Furthermore, the introduction of point of care ultrasound (POCUS) has triggered more individualized schemes of fluid therapy. This article explores the historical developments in the field of burn resuscitation, presenting different options to determine the fluid requirements without missing the red flags for hyper- or hypovolemia. Furthermore, the increasing rate of co-morbidities in burn patients calls for a more sophisticated fluid management adjusting the fluid therapy to the actual necessities very closely. Therefore, formulas might be used as a starting point, but further fluid therapy should be adjusted to the actual need of every single patient. Taking the developments in the field of individualized therapies in intensive care in general into account, fluid management in burn resuscitation will also be individualized in the near future.

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Burn Resuscitation

10.2310/7ccsp.8190 ◽

2018 ◽

Author(s):

Nicole Gibran ◽

Samuel P Mandell ◽

Theresa L. Chin

Keyword(s):

Wound Care ◽

Rescue Therapy ◽

Initial Period ◽

Total Body Surface Area ◽

Inhalation Injury ◽

Accurate Estimation ◽

High Dose ◽

Post Injury ◽

Secondary Survey ◽

Burn Resuscitation

Resuscitation of adult patients with burn size greater than 20% total body surface area (TBSA) and pediatric patients with burn size greater than 15% TBSA is essential for early survival due to the fluid shifts that occur after injury. After the primary and secondary survey, burn resuscitation is different from resuscitation from other types of shock because it is based on continuous fluid administration. Judicious use of fluids reduces fluid creep and complications of over-resuscitation. Accurate estimation of TBSA will improve the use of crystalloids. Furthermore, inhalation injury, chemical injury, electrical injury, and preexisting comorbidities can complicate resuscitation of these patients. Although crystalloids are the mainstay of therapy, adjuncts to resuscitation such as colloids, plasma exchange, and high-dose vitamin C have been considered to reduce complications of over-resuscitation or support patients who are refractory to typical resuscitation strategies in the initial period post injury. Wound care should never precede the primary and secondary survey and most often can wait until definitive care at a burn center. This review contains 5 figures, 6 tables and 54 references Key Words: burn, colloid, crystalloid, failing resuscitation, rescue therapy, resuscitation

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Burn resuscitation on the African continent

Burns ◽

10.1016/j.burns.2014.01.004 ◽

2014 ◽

Vol 40 (7) ◽

pp. 1283-1291 ◽

Cited By ~ 8

Author(s):

H. Rode ◽

A.D. Rogers ◽

S.G. Cox ◽

N.L. Allorto ◽

F. Stefani ◽

...

Keyword(s):

African Continent ◽

Burn Resuscitation

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Evaluation of effectiveness and safety of hydroxyethyl starch (HES 130 kDa/0.4) in burn resuscitation

Critical Care ◽

10.1186/cc10859 ◽

2012 ◽

Vol 16 (S1) ◽

Author(s):

A Mokline ◽

I Rahmani ◽

L Gharsallah ◽

H Oueslati ◽

B Gasri ◽

...

Keyword(s):

Hydroxyethyl Starch ◽

Burn Resuscitation

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A comparison of intranasal dexmeditomidine versus intranasal midazolam as a pre anesthetic medication in children undergoing adenotonsillectomy

QJM ◽

10.1093/qjmed/hcab086.091 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Nourhan M El Zoghby ◽

Ahmed S Mohammed ◽

Ahmed M El Hennawy ◽

Ramy M Wahba

Keyword(s):

Pediatric Patients ◽

Controlled Clinical Trial ◽

Physical Status ◽

University Hospitals ◽

Double Blind ◽

Institutional Ethics ◽

Pediatric Anesthesiologist ◽

Important Concern ◽

Anxiety Levels ◽

Intranasal Midazolam

Abstract Background Adenotonsillectomy is one of the most common surgical procedures performed on pediatric patients. Relieving pre- and post-operative anxiety is an important concern for the pediatric anesthesiologist. Aim of the Work: to compare dexmedetomidine with midazolam effect on preoperative sedation, the ease of children parent separation, the mask tolerance, intraoperative hemodynamics stability, emergence of anesthesia and postoperative analgesia. Patients and Methods A Prospective, randomized and double blind controlled clinical trial was done after approval of institutional ethics committee in Ain Shams university Hospitals for 6 months and obtaining an informed written consent from parents. It was designed to include fifty pediatric patients, aged 5 to 10 years old of both genders, with physical status ASA Ι. Results statistically significant increase mean of Dexmedetomidine compared to midazolam according to sedation score after 15min. to after 45min. Conclusion Premedication with intranasal dexmedetomidine 1 μg/kg attained significant and satisfactory sedation with better parent separation and lower anxiety levels without any adverse effects as compared with intranasal midazolam 0.2 mg/kg in children undergoing adenotonsillectomy.

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Electronic cigarettes: A narrative review of the implications for the pediatric anesthesiologist

Pediatric Anesthesia ◽

10.1111/pan.13885 ◽

2020 ◽

Vol 30 (6) ◽

pp. 653-659

Author(s):

Francois Lemay ◽

Paul Baker ◽

Hayden McRobbie

Keyword(s):

Electronic Cigarettes ◽

Narrative Review ◽

Pediatric Anesthesiologist

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787 Burn Resuscitation Critical Reflective Practice

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.364 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S228-S229

Author(s):

Jennifer Schoonard ◽

Jeanne Lee ◽

Eli Strait ◽

Jeremy Cabrera ◽

Jen Garner

Keyword(s):

Reflective Practice ◽

Patient Outcomes ◽

Interdisciplinary Teams ◽

Communication Process ◽

Team Members ◽

Staff Members ◽

Critical Reflective Practice ◽

Trauma Bay ◽

Burn Resuscitation ◽

Parkland Formula

Abstract Introduction The Burn Resuscitation Critical Reflective Practice (CRP) was started as collaborative meetings to review 1st 48 hours of admission for burn resuscitations (resus) October 2018- July 2019. All multi- disciplinary teams were invited. The problem identified was on average burn resus patients (>20% TBSA) were being over resuscitated in 1st 24 hours of admission. The goals of the CRP were: 1) Decrease resus fluid in the 1st 24 hours; 2) Increase knowledge of the current fluid resus pathway; 3) Increase communication with interdisciplinary teams during the resus. Methods CRP initiated in October 2018. 6 CRPs were held October 2018- July 2019.The average ml/ KG/ TBSA prior to CRP from January 2017- September 2018 was 5.17ml/kg/TBSA (goal: < 4ml). Chart reviews were done to gather data from each resus (i.e. urine output, fluids, labs, events). Discussions held with staff involved in the 1st 24 hours of resus regarding any communication/process issues.Patient data was presented & staff members present would discuss questions/ issues that came up during the resus. Multi-disciplinary teams surveyed prior to CRP to assess comfort/competence with current resus pathway and communication. 46 surveys received prior to initiating CRP. After initiating CRP October 2018- July 2019, staff members that had attended >1 CRP were post-surveyed. Results January 2017- October 2018 average ml/ KG/ TBSA was 5.17ml/kg/TBSA. October 2018- July 2019 POST CRP implementation, the avg ml/ KG/ TBSA was 3.86 ml LR/ kg/ TBSA in 1st 24 hours of resus. 3 new practices were implemented 1) Decrease fluids by 200ml/hr (instead of 100) when UOP is >100/hr at least 2 hours into resus; 2) Double sign by 2 RNs required when calculating Parkland Formula; 3) Guideline created to guide communication between Burn RNs & trauma bay when burn resus arrives. Post- survey data showed increase in comfort communicating with physicians regarding resus & increase in comfort/confidence in calculating Parkland Formula. 2 additional subjective questions were added onto the post- CRP survey. Conclusions Fluids given in the 1st 24 hours decreased from 5.17 to 3.86 average ml/ kg/ TBSA post- CRP. 3 new practices were implemented as discussed in results. Staff felt more comfortable communicating with team & calculating Parkland formula. Staff had positive responses on the post- survey. Applicability of Research to Practice The monthly CRPs are to be continued to discuss all burn resus patients received during the prior month. Allows team members to continue to modify practice as needed by what’s learned through each CRP to help better our patient outcomes and decrease overall resus fluids.

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Introduction: Burn Resuscitation

Critical Care Clinics ◽

10.1016/j.ccc.2016.06.011 ◽

2016 ◽

Vol 32 (4) ◽

pp. 489-490

Author(s):

Kevin N. Foster

Keyword(s):

Burn Resuscitation

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