SEVERELY BURNED PATIENT IN A PEDIATRIC INTENSIVE CARE UNIT – 20 YEARS EXPERIENCE
Keywords:Burned patient, child, Paediatric Intensive Care Unit
Background: Initial approach of severely burned patient until hemodynamic and hydroelectrolytic stabilization is crucial to minimize morbidity and mortality.
Material and methods: Retrospective descriptive and analytic study of all burned patients admitted in a Paediatric Intensive Care Unit during a 20 year period (between April/1991 and December/2010). Nosodemographic data, causal agent, severity and extension of burn, procedures, treatment, complications and outcome were analyzed.
Results: There were 137 admissions for burn, corresponding to 123 patients and to 1.8% of all admissions in the PICU. The median age was 3.6 years, and 62.4% were male. Higher incidence of cases was found in August (13.0%). Burning agents were: boiling liquid (38.1%), fire (38.1%) and electricity (23.9%). The median total body surface burned area was 30% (0.5 - 92.0%), 59.0% corresponding to third degree burns. Mechanical ventilation was needed in 45.5% and central venous catheter in 64.2% of patients. Complications included: sepsis (29.2%), respiratory failure (21.1%), cardiovascular failure (16.5%) and multiorgan failure (18.8%). Patients recovered in 88.6% of cases and there were 10 deaths (8.1%), nine of them in the first 10 years of the study, and nine due to infection. However, the paediatric risk of mortality score (PRISM, the therapeutic intervention scoring system (TISS) and the risk probability of death (RPM) were higher in the second decade.
Conclusion: In the last years of the study, despite the higher number of admissions and greater severity, there was a decrease in the number of deaths, which may be related to the improvement of care in these patients.
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