Management of Severely Burned Adult Patients: From Sedation to Organ Dysfunction (original) (raw)

Burns are devastating and debilitating injuries leading to high morbidity and mortality, emotional stress and they add to the financial burden. Severely burned patients should preferably be managed in burn centre with dedicated intensive care unit (ICU). Severity of burns are classified according to the degree of burns and total body surface area (TBSA) with burns. Rule of nine is used for calculation of TBSA with burn. Severe burns will cause cellular leak, hypovolemia, storm of proinflammatory markers and cardiovascular impairment leading to the burn shock and multiple organ dysfunction. Intensive care management of severe burns includes resuscitation and organ supportive care. There are number of formulae for fluid resuscitation in these patients, these formulas give initial guidance for fluid resuscitation and further fluid therapy should be guided by dynamic preload parameters. The opioids and benzodiazepines are frequently used for analgesia and sedation respectively whereas ketamine and dexmedetomidine have added advantage of opioid and benzodiazepine sparing effects. In these patient's hyperglycaemia and hypercatabolism should be controlled. ARDS (acute respiratory distress syndrome) occurs in up to 50% of the ventilated burns patient. High frequency percussive ventilation and use of ARDS adjuvant therapies will have better outcome. Acute kidney injury occurs in 30% of severe burns, renal replacement therapy should be started early. Early enteral feeds, gastric ulcer prophylaxis and adequate fluid resuscitation will prevent the GI dysfunction. Burns shock will improve with adequate fluid resuscitation and supportive care. The common neurological dysfunction in burns is delirium. Delirium should be managed with pharmacological and non-pharmacological therapies. There is a decreasing trend in the mortality of severely burns patients and it is around 10%.