Association between fluid creep and infection in burned children: A cohort study. Issue 5 (August 2020)

• Record Type: Journal Article
• Authors: Dittrich, Maria Helena M.; Hosni, Nicole Dittrich; de Carvalho, Werther B.
• Is Part Of: Burns. Volume 46:Issue 5(2020)
• Page Start: 1036
• Page End: 1042
• Publication Date: 2020-08
• Subjects: Infection -- Resuscitation -- Burns -- Albumins -- Cohort studies -- Edema; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2020.02.003
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: Pediatric patients that received early albumin had less fluid creep, skin graft procedures, and debridement. Burned children that received early albumin had a shorter length of stay in the hospital. Burned children who developed fluid creep were at increased risk of developing infection. Both the presence of fluid creep and length of hospital stay of more than 14 days were associated with infection. Abstract: Introduction: Aggressive fluid resuscitation has been extensively discussed after the establishment of fluid creep phenomenon as a morbidity and mortality factor in burn children. Sepsis is currently the leading cause of death in survivors of burn shock. Objectives: To evaluate the association between fluid creep and infection in burn children exposed to two different fluid resuscitation strategies with the use of albumin. Methods: A cohort of 46 burn children with 15–45% of body surface area (BSA) admitted up to 12 h after the incident were evaluated. Patients from early albumin group (n = 23) received 5% albumin between 8 and 12 h from injury and patients from delayed albumin group (n = 23) received 5% albumin after 24 h. Outcomes analysed were development of fluid creep, length of stay in the hospital, number of surgery procedures and infection until hospital discharge. Results: Compared to the delayed group, patients that received early albumin had a shorter length of stay in the hospital (p = 0.007), less fluid creep (4.3% × 56.5%) (p < 0.001), less skin graft procedure (47.8% × 78.3%) (p = 0.032) and less debridement (73.9% × 100%) (p = 0.022). Both length of stay in the hospital and fluid creep arising were associated with infection (p < 0.05). Conclusion: Fluid creep, surgery procedures and length of stay in hospital parameters showed better results in burn children treated with early albumin. Fluid creep and length of stay in the hospital were associated with infection, providing a negative prognosis.