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Semin Plast Surg
DOI: 10.1055/s-0044-1782647
Review Article

Critical Care of the Pediatric Burn Patient

Catherine Naber
1   Division of Pediatric Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
3   Shriners Children's -Boston- Boston, Massachusetts
,
Robert Sheridan
2   Sumner Redstone Burn Center, Sumner Redstone Burn Center, Boston, Massachusetts
3   Shriners Children's -Boston- Boston, Massachusetts
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Abstract

Life-saving pediatric burn care is often initiated in hospitals that are not designated as a pediatric burn center. Therefore, familiarity with critical care of pediatric burn patients is crucial for physicians working in all healthcare settings equipped to care for children. Management of airway, mechanical ventilation, preservation of ideal circulatory status, and establishment of vascular access in pediatric burn patients requires many unique considerations. This article aims to summarize important principles of critical care of children with significant burn injuries for review by physicians and surgeons working in hospitals designated as a pediatric burn center and those that stabilize these patients prior to referral.

Keywords

pediatric critical care - pediatric burn care - pain control


Publication History

Article published online:
04 April 2024

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  • References

  • 1 National Center for Injury Prevention and Control. 10 leading causes of death, United States, 2021. . Accessed March 13, 2024 at: https://wisqars.cdc.gov/lcd/?o=LCD&y1=2021&y2=2021&ct=10&cc=ALL&g=00&s=0&r=0&ry=0&e=0&ar=lcd1age&at=groups&ag=lcd1age&a1=0&a2=199
    PubMedGoogle Scholar
  • 2 National Center for Injury Prevention and Control. 10 Leading causes of nonfatal emergency department visits, United States, 2001 to 2020. 2020. Accessed September 15, 2023 at: https://wisqars.cdc.gov/lcnf/?y1=2001&y2=2020&ct=10&cc=0&s=0&g=00&a=lcd1age&a1=0&a2=199&d=0
    PubMedGoogle Scholar
  • 3 Greenhalgh DG. Burned children in U.S. PICUs-not a true representation of pediatric burn care. Pediatr Crit Care Med 2021; 22 (07) 672-673
    CrossrefPubMedGoogle Scholar
  • 4 Woodruff AG, Bass AL, McCrory MC. Navigating the multiverse: heterogeneity in pediatric burn care in the United States. Pediatr Crit Care Med 2022; 23 (11) 958-960
    CrossrefPubMedGoogle Scholar
  • 5 McCrory MC, Woodruff AG, Saha AK, Halvorson EE, Critcher BM, Holmes IV JH. Characteristics of burn-injured children in 117 U.S. PICUs (2009–2017): a retrospective virtual pediatric systems database study. Pediatr Crit Care Med 2021; 22 (07) 616-628
    CrossrefPubMedGoogle Scholar
  • 6 Palmieri TL, Taylor S, Lawless M, Curri T, Sen S, Greenhalgh DG. Burn center volume makes a difference for burned children. Pediatr Crit Care Med 2015; 16 (04) 319-324
    CrossrefPubMedGoogle Scholar
  • 7 Sheridan R, Weber J, Prelack K, Petras L, Lydon M, Tompkins R. Early burn center transfer shortens the length of hospitalization and reduces complications in children with serious burn injuries. J Burn Care Rehabil 1999; 20 (05) 347-350
    CrossrefPubMedGoogle Scholar
  • 8 Martens S, Romanowksi K, Palmieri T, Greenhalgh D, Sen S. Massive pediatric burn injury: a 10-year review. J Burn Care Res 2023; 44 (03) 670-674
    CrossrefPubMedGoogle Scholar
  • 9 Dries DJ, Endorf FW. Inhalation injury: epidemiology, pathology, treatment strategies. Scand J Trauma Resusc Emerg Med 2013; 21: 31
    CrossrefPubMedGoogle Scholar
  • 10 Campbell M, Sapra A. Physiology, Airflow Resistance [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2023. . Accessed September 10, 2023 at: https://www.ncbi.nlm.nih.gov/books/NBK554401/
    Google Scholar
  • 11 Hsu G, von Ungern-Sternberg BS, Engelhardt T. Pediatric airway management. Curr Opin Anaesthesiol 2021; 34 (03) 276-283
    CrossrefPubMedGoogle Scholar
  • 12 Garcia-Marcinkiewicz AG, Kovatsis PG, Hunyady AI. et al; PeDI Collaborative investigators. First-attempt success rate of video laryngoscopy in small infants (VISI): a multicentre, randomised controlled trial. Lancet 2020; 396 (10266): 1905-1913
    CrossrefPubMedGoogle Scholar
  • 13 Peyton J, Park R, Staffa SJ. et al; PeDI Collaborative Investigators. A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry. Br J Anaesth 2021; 126 (01) 331-339
    CrossrefPubMedGoogle Scholar
  • 14 Weaver LK. Clinical practice. Carbon monoxide poisoning. N Engl J Med 2009; 360 (12) 1217-1225
    CrossrefPubMedGoogle Scholar
  • 15 Huzar TF, George T, Cross JM. Carbon monoxide and cyanide toxicity: etiology, pathophysiology and treatment in inhalation injury. Expert Rev Respir Med 2013; 7 (02) 159-170
    CrossrefPubMedGoogle Scholar
  • 16 Chenoweth JA, Albertson TE, Greer MR. Carbon monoxide poisoning. Crit Care Clin 2021; 37 (03) 657-672
    CrossrefPubMedGoogle Scholar
  • 17 Sheridan RL, Shank ES. Hyperbaric oxygen treatment: a brief overview of a controversial topic. J Trauma 1999; 47 (02) 426-435
    CrossrefPubMedGoogle Scholar
  • 18 Geller RJ, Barthold C, Saiers JA, Hall AH. Pediatric cyanide poisoning: causes, manifestations, management, and unmet needs. Pediatrics 2006; 118 (05) 2146-2158
    CrossrefPubMedGoogle Scholar
  • 19 Garren BN, Akhondi-Asl A, DePamphilis MA, Burns JP, Sheridan RL. Factors associated with mechanical ventilation duration in pediatric burn patients in a regional burn center in the United States. Pediatr Crit Care Med 2022; 23 (11) e536-e540
    CrossrefPubMedGoogle Scholar
  • 20 Enkhbaatar P, Pruitt Jr BA, Suman O. et al. Pathophysiology, research challenges, and clinical management of smoke inhalation injury. Lancet 2016; 388 (10052): 1437-1446
    CrossrefPubMedGoogle Scholar
  • 21 Elsharnouby NM, Eid HE, Abou Elezz NF, Aboelatta YA. Heparin/N-acetylcysteine: an adjuvant in the management of burn inhalation injury: a study of different doses. J Crit Care 2014; 29 (01) 182.e1-182.e4
    CrossrefPubMedGoogle Scholar
  • 22 Enkhbaatar P, Herndon DN, Traber DL. Use of nebulized heparin in the treatment of smoke inhalation injury. J Burn Care Res 2009; 30 (01) 159-162
    CrossrefPubMedGoogle Scholar
  • 23 Wilmot RW, Boat TF, Bush A, Chernick V, Deterding RR, Ratjen F. Chapter 40: Lung injury from hydrocarbon aspiration and smoke inhalation. In: Kendig and Chernick's Disorders of the Respiratory Tract in Children. 8th ed.. Philadelphia, PA: Elsevier; 2012: 595-599
    Google Scholar
  • 24 Emeriaud G, López-Fernández YM, Iyer NP. et al; Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) Group on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Executive summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2). Pediatr Crit Care Med 2023; 24 (02) 143-168
    CrossrefPubMedGoogle Scholar
  • 25 Khemani RG, Parvathaneni K, Yehya N, Bhalla AK, Thomas NJ, Newth CJL. Positive end-expiratory pressure lower than the ARDS network protocol is associated with higher pediatric acute respiratory distress syndrome mortality. Am J Respir Crit Care Med 2018; 198 (01) 77-89
    CrossrefPubMedGoogle Scholar
  • 26 Pisano C, Fabia R, Shi J. et al. Variation in acute fluid resuscitation among pediatric burn centers. Burns 2021; 47 (03) 545-550
    CrossrefPubMedGoogle Scholar
  • 27 Goverman J, Bittner EA, Friedstat JS. et al. Discrepancy in initial pediatric burn estimates and its impact on fluid resuscitation. J Burn Care Res 2015; 36 (05) 574-579
    CrossrefPubMedGoogle Scholar
  • 28 Cancio LC. Initial assessment and fluid resuscitation of burn patients. Surg Clin North Am 2014; 94 (04) 741-754
    CrossrefPubMedGoogle Scholar
  • 29 Atiyeh BS, Dibo SA, Ibrahim AE, Zgheib ER. Acute burn resuscitation and fluid creep: it is time for colloid rehabilitation. Ann Burns Fire Disasters 2012; 25 (02) 59-65
    PubMedGoogle Scholar
  • 30 Lawrence A, Faraklas I, Watkins H. et al. Colloid administration normalizes resuscitation ratio and ameliorates “fluid creep”. J Burn Care Res 2010; 31 (01) 40-47
    CrossrefPubMedGoogle Scholar
  • 31 Sheridan RL, Tompkins RG. What's new in burns and metabolism. J Am Coll Surg 2004; 198 (02) 243-263
    CrossrefPubMedGoogle Scholar
  • 32 Finnerty CC, Mabvuure NT, Ali A, Kozar RA, Herndon DN. The surgically induced stress response. JPEN J Parenter Enteral Nutr 2013; 37 (5, Suppl): 21S-29S
    CrossrefPubMedGoogle Scholar
  • 33 Karaaslan A, Çetin C, Köle MT. et al. Infections in pediatric patients with burn injury: 6 years of experience. Pediatr Infect Dis J 2023; 42 (01) 8-12
    CrossrefPubMedGoogle Scholar
  • 34 Sheridan RL. Sepsis in pediatric burn patients. Pediatr Crit Care Med 2005; 6 (3, Suppl): S112-S119
    CrossrefPubMedGoogle Scholar
  • 35 Parish RA, Novack AH, Heimbach DM, Engrav LR. Fever as a predictor of infection in burned children. J Trauma 1987; 27 (01) 69-71
    CrossrefPubMedGoogle Scholar
  • 36 Weiss SL, Peters MJ, Alhazzani W. et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med 2020; 21 (02) e52-e106
    CrossrefPubMedGoogle Scholar
  • 37 Griggs C, Goverman J, Bittner EA, Levi B. Sedation and pain management in burn patients. Clin Plast Surg 2017; 44 (03) 535-540
    CrossrefPubMedGoogle Scholar
  • 38 Smith HAB, Besunder JB, Betters KA. et al. 2022 Society of Critical Care Medicine clinical practice guidelines on prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility. Pediatr Crit Care Med 2022; 23 (02) e74-e110
    CrossrefPubMedGoogle Scholar
  • 39 Smith HAB, Gangopadhyay M, Goben CM. et al. Delirium and benzodiazepines associated with prolonged ICU stay in critically ill infants and young children. Crit Care Med 2017; 45 (09) 1427-1435
    CrossrefPubMedGoogle Scholar
  • 40 Traube C, Silver G, Gerber LM. et al. Delirium and mortality in critically ill children: epidemiology and outcomes of pediatric delirium. Crit Care Med 2017; 45 (05) 891-898
    CrossrefPubMedGoogle Scholar
  • 41 Deeter KH, King MA, Ridling D, Irby GL, Lynn AM, Zimmerman JJ. Successful implementation of a pediatric sedation protocol for mechanically ventilated patients. Crit Care Med 2011; 39 (04) 683-688
    CrossrefPubMedGoogle Scholar
  • 42 Sperotto F, Mondardini MC, Dell'Oste C. et al; Pediatric Neurological Protection and Drugs (PeNPAD) Study Group of the Italian Society of Neonatal and Pediatric Anesthesia and Intensive Care (SARNePI). Efficacy and safety of dexmedetomidine for prolonged sedation in the PICU: a prospective multicenter study (PROSDEX). Pediatr Crit Care Med 2020; 21 (07) 625-636
    CrossrefPubMedGoogle Scholar
  • 43 Fagin A, Palmieri T, Greenhalgh D, Sen S. A comparison of dexmedetomidine and midazolam for sedation in severe pediatric burn injury. J Burn Care Res 2012; 33 (06) 759-763
    CrossrefPubMedGoogle Scholar
  • 44 Shutes BL, Gee SW, Sargel CL, Fink KA, Tobias JD. Dexmedetomidine as single continuous sedative during non invasive ventilation: typical usage, hemodynamic effects and withdrawal. Pediatr Crit Care Med 2018; 19 (04) 287-297
    CrossrefPubMedGoogle Scholar
  • 45 Stoddard Jr FJ, Sorrentino E, Drake JE. et al. Posttraumatic stress disorder diagnosis in young children with burns. J Burn Care Res 2017; 38 (01) e343-e351
    CrossrefPubMedGoogle Scholar
  • 46 Pardesi O, Fuzaylov G. Pain management in pediatric burn patients: review of recent literature and future directions. J Burn Care Res 2017; 38 (06) 335-347
    CrossrefPubMedGoogle Scholar
  • 47 Kaya M, Karaman Özlü Z. The effect of virtual reality on pain, anxiety, and fear during burn dressing in children: a randomized controlled study. Burns 2023; 49 (04) 788-796
    CrossrefPubMedGoogle Scholar
  • 48 Prelack K, Dylewski M, Sheridan RL. Practical guidelines for nutritional management of burn injury and recovery. Burns 2007; 33 (01) 14-24
    CrossrefPubMedGoogle Scholar
  • 49 Shahi N, Skillman HE, Phillips R. et al. Why delay? Early enteral nutrition in pediatric burn patients improves outcomes. J Burn Care Res 2021; 42 (02) 171-176
    CrossrefPubMedGoogle Scholar
  • 50 Dylewksi ML, Baker M, Prelack K. et al. The safety and efficacy of parenteral nutrition among pediatric patients with burn injuries. Pediatr Crit Care Med 2013; 14 (03) e120-e125
    CrossrefPubMedGoogle Scholar
  • 51 Prelack K, Yu YM, Dylewski M. et al. Measures of total energy expenditure and its components using the doubly labeled water method in rehabilitating burn children [published online August 5. JPEN J Parenter Enteral Nutr 2017; 41 (03) 470-480
    CrossrefPubMedGoogle Scholar
  • 52 Rousseau AF, Losser MR, Ichai C, Berger MM. ESPEN endorsed recommendations: nutritional therapy in major burns. Clin Nutr 2013; 32 (04) 497-502 Erratum in: Clin Nutr. 2013 Dec;32(6):1083. PMID: 23582468
    CrossrefPubMedGoogle Scholar
  • 53 Graves C, Saffle J, Cochran A. Actual burn nutrition care practices: an update. J Burn Care Res 2009; 30 (01) 77-82
    CrossrefPubMedGoogle Scholar
  • 54 Fitzgerald O'Connor E, Frew Q, Din A. et al. Periorbital burns – a 6-year review of management and outcome. Burns 2015; 41 (03) 616-623
    CrossrefPubMedGoogle Scholar
  • 55 Kayambu G, Boots R, Paratz J. Early physical rehabilitation in intensive care patients with sepsis syndromes: a pilot randomised controlled trial. Intensive Care Med 2015; 41 (05) 865-874
    CrossrefPubMedGoogle Scholar