[Therapy of the severely burned child from the pediatric intensive care viewpoint].

All burn injuries involving more than 10% of the total body surfaces in children necessitate immediate fluid replacement. Such patients should be admitted to a hospital with an intensive care unit specialized in dealing with such accidents. Fluid replacement should be started, with administration of an isotonic electrolyte solution, such as lactated Ringer's, to avoid severe burn shock. Several other fluid replacement protocols have been proposed. Controversy exists as to whether a hypertonic or hypotonic solution should be used and whether or not colloid should be added to these solutions. The findings of controlled studies have not shown any differences with regard to morbidity or mortality. Dextran solution helps to stabilize the circulation during the first few hours. In addition, albumin should be given from 8 to 24 h post-injury. Most burned children require central venous catheters for intravenous fluid supplementation. The adequacy of fluid replacement must be assessed by a variety of clinical parameters, beginning with urinary excretion of above 0.5-1.0 ml/kg per hour. Acute management of burned children includes adequate analgesia with potent drugs. Opioids or ketamine should be given to avoid pain and pain-related depression of the circulation. Adequate intensive care of inhalation trauma, sepsis, prevention of multi-organ failure, early enteral feeding and limited prophylactic use of antibiotics can reduce mortality in these severely ill children.