• Ashish Nagpal, Melissa-Moore Clingenpeel, Rajan K Thakkar, Renata Fabia, and Jeffrey Lutmer.
• Department of Pediatrics, Division of Critical Care Medicine, The Children's Hospital at OU Medical Center, 1200 Children's Ave, Oklahoma City, OK, 73104, United States. Electronic address: ashish-nagpal@ouhsc.edu.
• Burns. 2018 Aug 1; 44 (5): 1308-1316.

ObjectiveTo determine the association between fluid resuscitation volume following pediatric burn injury and impact on outcomes.MethodsA retrospective chart review of pediatric patients (0-18 years) sustaining ≥15% TBSA burn, admitted to an American Burn Association verified pediatric burn center from 2010 to 2015.ResultsTwenty-seven patients met inclusion criteria and had complete data available for analysis. Fifteen (56%) patients received greater than 6ml/kg/total body surface area burn in first 24h and twelve (44%) patients received less than 6ml/kg/percent total body surface area burn in first 24h. There were no differences between groups in median number of mechanical ventilator days (4 vs 8, p=0.96), intensive care unit length of stay (10 vs 13.5, p=0.75), or hospital length of stay (37 vs 37.5, p=0.56). Secondary analysis revealed that patients with a higher mean cumulative fluid overload (>253ml/kg, n=16) had larger burn size, higher injury severity scores, and were more likely to receive mechanical ventilation and invasive support devices. Controlling for burn size, odds of longer PICU length of stay and duration of mechanical ventilation were 20.33 [95% CI (1.7-235.6) p=0.02] and 27.9 [95% CI (2.1-364.7) p=0.01], respectively, among patients with a high cumulative fluid overload on day 3 compared to low cumulative fluid overload.ConclusionsResuscitation volume in the first 24h was not associated with adverse outcomes. Persistent cumulative fluid overload at day 3 and beyond was independently associated with adverse outcomes.Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.

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