Burn-induced cardiac dysfunction increases length of stay in pediatric burn patients

Abstract

The aim of this study was to evaluate cardiac function and clinical outcomes in perioperative pediatric burn patients. Transesophageal echocardiography data were collected on 40 patients from 2004 to 2007. Of the 40 patients who received exams, a complete set of cardiac parameters and outcome variables was obtained in 26 patients. The mean age of the patients was 9.7 ± 0.9 years, and the mean TBSA burn size was 64 ± 3%. Patients were divided into two groups based on systolic function. One group represented patients with ejection fractions of >50% and the other ≤50%. Clinical variables were then compared among the groups. In our cohort, systolic dysfunction was observed in 62% of patients (EF ≤ 50%). Systolic dysfunction was associated with a statistically significant increase in number of surgeries, ventilator days, and length of stay in the intensive care unit. The length of stay in patients with preserved systolic function and those with systolic dysfunction was 34.3 ± 3.3 days and 67.2 ± 4.0 days, respectively. Diastolic function measurements were obtained in 65%, and 88% had evidence of diastolic dysfunction. Diastolic dysfunction was not associated with any statistically significant correlations. This study lends evidence to the well-supported basic science models showing cardiac dysfunction after burns. Additionally, it shows that cardiac dysfunction can have clinical consequences. To our knowledge, this is the first study that shows the clinical sequelae of systolic dysfunction in the perioperative pediatric burn population.

Figures

Figure 1

Creatinine versus systolic function in children with ≥35% total burn surface area. Just over one third of patients with systolic dysfunction (EF ≤50%, n=16) showed elevated creatinine levels compared to none in the preserved function group (EF >50%, n=10).

Figure 2

Systolic function and pressor support during echocardiography of children with ≥35% total burn surface area. Use of cardiovascular supportive agents was independent of systolic function for both preserved (EF >50%) and dysfunctional (EF ≤50%) systolic function groups.

Figure 3

Intensive care unit length of stay (LOS) according to systolic function. LOS was significantly greater for the depressed systolic function group (p