The use of extracorporeal life support in pediatric burn patients with respiratory failure

Michael J. Goretsky, David G Greenhalgh, Glenn D. Warden, Frederick C. Ryckman, Brad W. Warner

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Respiratory failure is the most common cause of death after thermal injury and may be caused by inhalation injury, acute respiratory distress syndrome (ARDS) or pneumonia. ARDS is usually associated with sepsis; however, it may also occur during burn shock, especially in patients that have a delayed or inadequate fluid resuscitation.1 During the past 24 months, five pediatric burn patients underwent extracorporeal life support (ECLS) for respiratory failure unresponsive to optimal medical management. The mean age of the patients was 26 months (range, 8.5 to 48 months), with a mean burn size of 46% TBSA (>95% third degree). The etiology of the respiratory failure included severe bronchospasm in a 22-month-old former premature infant with bronchopulmonary dysplasia; three patients with ARDS; and one patient with a severe inhalation injury. All five patients required greater than 56 cm H2O peak pressures and 100% Fio2 at the time of beginning ECLS. The oxygenation index (OI) ranged from 45 to 180. Three (60%) of the patients survived. In the three patients who ultimately survived, significant improvements in pulmonary and hemodynamic parameters occurred within 96 hours of ECLS. The two patients who died showed no improvement and were removed from ELCS at 10 and 11 days; both expired within hours. The patients who expired developed significant hemodynamic instability, coagulopathy, and hemorrhage from their burn wounds. The extent and degree of burn injury did not seem to alter the outcome. Indications for considering ECLS in the pediatric burn patient are unmanageable, life threatening pulmonary insufficiency in patients that undergo a relative short course of pre-ECLS ventilator support. The principles consist of survivors showing a rapid improvement; and if possible, initial excision and allografting before support should be beneficial. ECLS appears to be a viable therapy for burned children with acute respiratory failure when maximal conventional pulmonary support is failing.

Original languageEnglish (US)
Pages (from-to)620-623
Number of pages4
JournalJournal of Pediatric Surgery
Volume30
Issue number4
StatePublished - Apr 1995
Externally publishedYes

Fingerprint

Extracorporeal Membrane Oxygenation
Respiratory Insufficiency
Pediatrics
Adult Respiratory Distress Syndrome
Wounds and Injuries
Lung
Inhalation
Beginning of Human Life
Hemodynamics
Bronchopulmonary Dysplasia
Bronchial Spasm
Homologous Transplantation
Mechanical Ventilators
Premature Infants
Survivors
Cause of Death
Shock
Sepsis
Pneumonia
Hot Temperature

Keywords

  • burns in children
  • Extracorporeal life support

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Goretsky, M. J., Greenhalgh, D. G., Warden, G. D., Ryckman, F. C., & Warner, B. W. (1995). The use of extracorporeal life support in pediatric burn patients with respiratory failure. Journal of Pediatric Surgery, 30(4), 620-623.

The use of extracorporeal life support in pediatric burn patients with respiratory failure. / Goretsky, Michael J.; Greenhalgh, David G; Warden, Glenn D.; Ryckman, Frederick C.; Warner, Brad W.

In: Journal of Pediatric Surgery, Vol. 30, No. 4, 04.1995, p. 620-623.

Research output: Contribution to journalArticle

Goretsky, MJ, Greenhalgh, DG, Warden, GD, Ryckman, FC & Warner, BW 1995, 'The use of extracorporeal life support in pediatric burn patients with respiratory failure', Journal of Pediatric Surgery, vol. 30, no. 4, pp. 620-623.
Goretsky, Michael J. ; Greenhalgh, David G ; Warden, Glenn D. ; Ryckman, Frederick C. ; Warner, Brad W. / The use of extracorporeal life support in pediatric burn patients with respiratory failure. In: Journal of Pediatric Surgery. 1995 ; Vol. 30, No. 4. pp. 620-623.
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