Acute Respiratory Failure That Complicates the Resuscitation of Pediatric Patients With Scald Injuries
作者:
Andrew Zak,
David Harrington,
David Barillo,
David Lawlor,
Khan Shirani,
Cleon Goodwin,
期刊:
Journal of Burn Care & Rehabilitation
(OVID Available online 1999)
卷期:
Volume 20,
issue 5
页码: 391-399
ISSN:0273-8481
年代: 1999
出版商: OVID
数据来源: OVID
摘要:
Respiratory failure that requires endotracheal intubation is an uncommon but potentially fatal complication of scald burns in children. Because scalds are rarely associated with a direct pulmonary injury, the pathophysiology of respiratory failure is unclear. A possible mechanism may be upper airway edema, diminished pulmonary compliance secondary to fluid resuscitation, or both. To identify an at-risk population for intubation after a scald injury, the hospital courses of 174 consecutive patients under the age of 14 years who were admitted after a scald injury to a single burn center during a 6-year period were examined. Seven of these patients (4%) required endotracheal intubation. No patient older than 2.8 years or who had a scald injury that covered less than 19% of the total body surface area required intubation. Patients who required intubation were younger (mean age, 1.4 vs 2.8 years,P< .001), had a larger mean burn size (29.9% vs. 12.3% total body surface area,P< .001), and required more fluid resuscitation (7.66 vs. 4.07 cc/kg per percentage of total body surface area burned,P< .001) than patients who did not require intubation. Examination of the adequacy of resuscitation revealed that the intubated patients had an average hourly urine output of 0.84 cc/kg during the first 24 hours, suggesting that resuscitation was not excessive. Multivariate analysis demonstrated that both larger burn size (P= .041) and younger age (P= .049) were independent predictors of the need for intubation. Young patients with large body surface area burns that required large volumes of resuscitation comprise an at-risk group for respiratory failure after a scald injury. Increased vigilance is merited during the resuscitation of these patients. (J Burn Care Rehabil 1999;20:391–9)
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