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Fluid resuscitation in paediatric burns: how do we get it right? A systematic review of the evidence
  1. Christopher Stutchfield1,
  2. Anna Davies2,
  3. Amber Young3,4
  1. 1 Paediatric Intensive Care, Bristol Royal Hospital for Children, Bristol, UK
  2. 2 Centre for Academic Child Health, University of Bristol, Bristol, UK
  3. 3 School of Social and Community Medicine, University of Bristol, Bristol, UK
  4. 4 University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  1. Correspondence to Dr Amber Young, Anaesthetic Department, Bristol Royal Hospital for Children, Bristol, BS2 8BJ, UK; amber.young1{at}nhs.net

Abstract

Background Optimal fluid resuscitation in children with major burns is crucial to prevent or minimise burn shock and prevent complications of over-resuscitation.

Objectives To identify studies using endpoints to guide fluid resuscitation in children with burns, review the range of reported endpoint targets and assess whether there is evidence that targeted endpoints impact on outcome.

Design Systematic review.

Methods Medline, Embase, Cinahl and the Cochrane Central Register of Controlled Trials databases were searched with no restrictions on study design or date. Search terms combined burns, fluid resuscitation, endpoints, goal-directed therapy and related synonyms. Studies reporting primary data regarding children with burns (<16 years) and targeting fluid resuscitation endpoints were included. Data were extracted using a proforma and the results were narratively reviewed.

Results Following screening of 777 unique references, 7 studies fulfilled the inclusion criteria. Four studies were exclusively paediatric. Six studies used urine output (UO) as the primary endpoint. Of these, one set a minimum UO threshold, while the remainder targeted a range from 0.5–1.0 mL/kg/hour to 2–3 mL/kg/hour. No studies compared different UO targets. Heterogeneous study protocols and outcomes precluded comparison between the UO targets. One study targeted invasive haemodynamic variables, but this did not significantly affect patient outcome.

Conclusions Few studies have researched resuscitation endpoints for children with burns. Those that have done so have investigated heterogeneous endpoints and endpoint targets. There is a need for future randomised controlled trials to identify optimal endpoints with which to target fluid resuscitation in children with burns.

  • anaesthetics
  • intensive care
  • paediatric practice
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Footnotes

  • Contributors Formulation of research question and search strategy: CJS, AD, AY. Database searches: AD. Screening of studies: CJS, AD. Data extraction and analysis: CJS, AD. Paper editing: CJS, AD, AY.

  • Funding None received

  • Disclaimer The views expressed are those of the authors and not necessarily those of the Scar Free Foundation or other funding bodies.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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