Raslina Shrestha, MBBS

Nominated From: University Of Washington

Research Site: Nepal Cleft and Burn Center

Research Area: Trauma and Injury Prevention

Primary Mentors: Dr. Barclay Stewart, Dr. Shankar Man Rai

Research Project

Effectiveness and implementation of enteral resuscitation for children with major burn injuries in Nepal

Pediatric burns represent a significant cause of unintentional injury-related deaths worldwide. It is crucial to administer timely and effective resuscitation in cases of major burn injuries to prevent avoidable fatalities and long-term disabilities resulting from shock, acute kidney injury, lung injury, wound depth progression, and organ dysfunction. However, delays in initiating resuscitation are frequently observed, particularly in low- and middle-income countries. Moreover, children face additional challenges due to difficulties in obtaining intravenous access and the lack of appropriately sized resuscitation supplies. To address these issues, we intend to conduct a pilot study investigating the feasibility and efficacy of a simplified resuscitation approach using oral rehydration solution, which is more readily available compared to intravenous fluids (standard of care). By assessing the effectiveness of enteral resuscitation for children with major burn injuries and identifying key implementation considerations, we aim to uncover potential opportunities for reducing resuscitation delays and enhancing outcomes, particularly in challenging environments where specialized expertise is lacking.

Research Significance

The majority of individuals who sustain burn injuries each year reside in low- and middle-income countries (LMICs), with a particularly high incidence amongst children. Many of these individuals face significant barriers when it comes to accessing immediate burn care centers, resulting in delays in resuscitation. This contributes to a distressing number of preventable deaths and disabilities. However, these challenges can be addressed by implementing a strategy that enables patients, their families, and medical personnel to provide resuscitation close to the point of injury. Enteral resuscitation, which is a simple and operationally advantageous approach, has demonstrated both safety and efficacy and is readily available. However, there is a lack of controlled studies of enteral resuscitation compared to the standard intravenous (IV) resuscitation, particularly in the pediatric population. Therefore, this study aims to address this gap in knowledge and provide valuable insights into resuscitation protocols and enteral resuscitation in resource-limited settings with a potential to have a high impact and direct benefit for children injured where burn expertise is not immediately available (i.e., the vast majority of the world) and lead to global changes in resuscitation standards.


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