Intensive care of children and adolescents with severe burns in hospital settings

Severe burn injury (BI) is a condition frequently seen in pediatric intensive care practice, and its occurrence requires immediate admission of the patient to the intensive care unit. A child with 10% or more of their total body surface area affected may go into a state of burn shock, which does not produce noticeable hemodynamic and cerebral disturbances in the first few hours. Common aspects of emergency care include restoring airway patency and ensuring venous access, a task that may be complicated by skin burns. In severe BI, one obligatory component is fluid management, preferably with balanced crystalloid solutions, while the use of colloids is controversial. Enteral feeding must rely on formulas rich in protein, carbohydrates and micronutrients. Children with severe BI need adequate pain relief and sedation, as well as antibacterial treatment if an infection is found. Preventive steps should be taken against the development of stress ulcers. In the event of respiratory decompensation, the child is intubated and placed on mechanical ventilation; in the event of acute kidney injury, renal replacement therapy is initiated. The article describes specific details and aspects of intensive therapy in children and adolescents with inhalation injuries, carbon monoxide and cyanide poisoning, and electrical injury. The quality of inpatient emergency care in cases of BI should be improved in order to improve intensive treatment outcomes in this category of patients.

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