Update Management of Pediatric Burns: Fluid Resuscutation, Metabolic Care, Infection Control and Surgical Treatment of the Burns Wound

Children, especially younger ones, form a risky group among burned patients. A severe burn injury is not only a life threatening problem for injured children, but may have serious physical, psychosocial and financial effects on them, their families and the society. Although the number of burned victims among children has been decreasing in most of the European countries, including Croatia, during the last two decades, the complex pathophysiology of the severe burn injury still makes it one of the most demanding therapeutic challenges. Recent advances in intensive care, and knowledge of the pathophysiology of burns shock have a strong impact on the four mainstays of supportive treatment in burned children: fluid replacement, metabolic care, prevention of infection and early excision and grafting. Serious burns among have three distinct characteristics. In the first place a great incidence of burn shock is presented, which may be lethal to patients with large burns during the first week post injury. Next, burn wound infection and sepses occur often and commonly kill patients who survive the burn shock during the few post burn weeks. Finally, there is a great incidence of post burn deformities in patient who survive the healing process of their wound, which depend on the appearance of contractions and hypertrophic scaring. In recent years, there has been an important shift in the understanding of and approach to fluid resuscitation, fuelled largely by the increasing recognition that modern crystalloid resuscitation frequently provides substantial volumes of fluid, often exceeding the amount predicted by current formulas, resulting in edema related complications "Fluid creep" (1). The today consensus is to perform resuscitation on the individual bases what is dramatically reduces the mortality rate from burn shock. The hypermetabolic stress is responsible for severe catabolism, immune dysfunction, and profound physiologic perturbations affects in every burned child with burns greater than 40% of its total body surface area (TBSA). This response is pervasive and prolonged and cannot be completely abolished despite the pharmacology and non-pharmacology interventions (2). After the initial resuscitation, burn wound infection and sepsis still present a leading causes of morbidity and mortality, and remains one of the most challenging concerns for future investigation. Most superficial burns will heal with topical 1Division for Plastic Surgery and Burns, Department of Surgery, University Hospital Centre Split 2Division of Surgery, University Hospital Dubrava, Zagreb 3Department for Anesthesiology and Intensive Care Unit, University Hospital Centre Split 4Paediatric Clinic, University Hospital Centre Split