Optimization of infusional therapy in burn shock in children

Abstract

Severe thermal injury in children causes significant changes of electrolytic and proteic balances with an early development of multiple organ failure syndromes. Till present days, issues regarding the stabilization of blood circulation indicators in children with bum shock remain unsolved. Restoring the circulatory volume is usually done mostly by the infusional therapy. The calculation of fluid needs vary depending on age, weight and the area of the burned surface. The most used formula for calculation of fluid needs is the Parkland formula - 3-4 ml / kg /% of the bum surface of crystalloid solutions during the first 24 hours. A more grounded approach to fluid therapy in children is the Carvajal formula, based on the fact that the ratio of surface area to body weight in children is bigger than in adults: 2000 ml Ringer lactate for 1 m2 of total body surface area + 5000 ml of Ringer lactate for 1 m2 of the bums surface. P. Y. Gueugniaud et al. propose the use of crystalloid solutions Ringer lactate only in the first 6 h after the injury, in a dose of 1 ml / kg /% bum area. In the next 18 hours of crystalloids in doses of lml/kg /% bum area and colloids in doses of 1 ml / kg /% bum are prescribed. The total volume of infusion therapy should not exceed 4 ml / kg /% bum area during the first 24 hours. K. Okabayashi et al. consider that it is possible to increase the volume of fluids injected in children with massive bums in the first day after injury from 7 to 9.4 ml / kg /% bum. The next day, 50% of the first day dose is used. After 48 h or more, infusion therapy is calculated by the sum of physiological needs and the pathological (abnormal) losses. The issue regarding inclusion of colloidal solutions in the anti-shock measures is currently under discussion. In some of clinical centers, colloidal solutions are recommended in 12-24 hours after the injury - the time when capillary permeability may partially return to normal. However, the albumin infusions to patients during clinical stabilization after an adequate resuscitation with crystalloid infusion therapy resulted in a significant decrease in glomerular filtration rate, despite the increase of plasma volume. Some authors believe that the application of colloidal, protein solutions and / or hypertonic solutions of sodium chloride can reduce the volume of injected fluid. The use of hypertonic solutions may lead to the development of hypematraemia, hyperosmolarity and an increase of edema in the burned area. There are evidences of the development of renal failure in patients with severe thermal injury, in which a complex anti-shock therapy included hypertonic sodium chloride solution. Despite this, authors consider the application of this solution in the treatment of critical bum shock justified. In general, an infusion therapy program for patients with bum shock is a complex, multi-faceted and highly actual issue.