FLUID RESUSCITATION OF PEDIATRIC BURN VICTIMS - A CRITICAL-APPRAISAL

The objectives of fluid therapy in the burned child can be simply stated and defined, and they should represent the basis for the resuscitation process. During the first 24 h after the burn, the ultimate goal is restoration of the patient's volume and electrolyte homeostasis. All efforts should be directed at monitoring or restoring organ function while simultaneously minimizing edema formation. Only the minimum amount of fluids and other nutrients needed to restore cell function should be provided. Electrolyte deficits and lactic acidosis must be promptly corrected and every attempt should be made to prevent further derangement in body homeostasis by replacing concurrent losses and anticipating maintenance fluid and electrolyte requirements. Restoration and maintenance of perfusion pressures should lead to maximal oxygenation of injured and noninjured tissues, which promotes spontaneous healing, minimizes wound conversion, decreases bacterial colonization and prepares the injured areas for early excision and grafting. It must be emphasized, however, that restoration of fluid and electrolyte balance and organ function does not necessarily imply a return to normal of all physiological variables. The cardiac output, for example, may not return to preburn levels for 24-48 h post injury, even when the intravascular volume has been completely replenished. Likewise, oliguria may persist for 48-72 h, or even longer, after the burn, as a result of excessive secretion of antidiuretic hormone stimulated by the stress of the injury rather than its effect on fluid balance. Thus, while the objectives can be easily enumerated and defined, they are difficult to meet.