Association between fluid creep and infection in burned children: A cohort study

Authors: Dittrich, M. H. M., Hosni, N. D., and de Carvalho, W. B.

Publication: Burns 2020

Affiliations: Federal University of Sao Paulo, Escola Paulista De Medicina, Sao Paulo, Brazil; Children’s Institute, University of Sao Paulo, Sao Paulo, Brazil.

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% x 56.5%) (p < 0.001), less skin graft procedure (47.8% x 78.3%) (p = 0.032) and less debridement (73.9% x 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.