Management of Severely Burned Adult Patients: From Sedation to Organ Dysfunction (original) (raw)
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Management of Critical Burn Injuries: Recent Developments
Background: Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve vital organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage problems related to thermal injury, including lightning and electrical injuries. Methods: A selected review is provided of key management concepts as well as of recent reports published by the American Burn Association. Results: The burn-injured patient is easily and frequently over resuscitated, with ensuing complications that include delayed wound healing and respiratory compromise. A feedback protocol designed to limit the occurrence of excessive resuscitation has been proposed , but no new "gold standard" for resuscitation has replaced the venerated Parkland formula. While new medical therapies have been proposed for patients sustaining inhalation injury, a paradigm-shifting standard of medical therapy has not emerged. Renal failure as a specific contributor to adverse outcome in burns has been reinforced by recent data. Of special problems addressed in burn centers, electrical injuries pose multisystem physiologic challenges and do not fit typical scoring systems. Conclusion: Recent reports emphasize the dangers of over resuscitation in the setting of burn injury. No new medical therapy for inhalation injury has been generally adopted, but new standards for description of burn-related infections have been presented. The value of the burn center in care of the problems of electrical exposure, both manmade and natural, is demonstrated in recent reports.
Clinical Outcome of Patients With Severe Burns Presenting to the Emergency Department
Journal of Current Surgery, 2012
Background: Burns are a leading cause of morbidity and mortality worldwide. Although a local burn covering a limited surface area can heal readily, deep or extensive burns can result in systemic damage and even death. This study evaluated the clinical characteristics of the patients presenting with severe burns and investigated the factors influencing mortality. Methods: The data for 1003 patients who presented with symptoms of severe burn to a tertiary care university hospital in Turkey between 2006 and 2007 were evaluated retrospectively. Results: The overall patient mortality was 7.7% (n = 78). The effect of male gender and age on mortality was significant. The highest mortality rate was in the group aged > 40 years. A burned area larger than 21% of the body surface conferred a high risk of mortality. A hospital stay for longer than 10 days, the presence of delirium at the time of presentation, hyperuricemia, the need for debriding, grafting, or fasciotomy, sepsis, hypovolemic shock, and a positive blood culture were significant predictors of mortality. Conclusions: Severe burns have to be treated in a burn unit or burn center. As the prevention of burns is important, it is important to identify the region-specific causes of burns and the risk factors that influence mortality.
Cureus
Critically ill burn patients pose several unique challenges to care providers. The concepts of fluid resuscitation, nutritional management, organ support and wound care are rapidly evolving. There is a pressing need to review emerging evidence and incorporate these into practice for the effective management of burn patients. We have searched the PubMed and Google Scholar databases to review the current evidence on the acute care management of adult as well as paediatric burn patients. The rationales for current practices have been integrated into the review. The management of critically ill burn patients requires an in-depth knowledge of the pathophysiology of burn injury, a tailored approach for timely resuscitation, timely diagnosis of organ specific problems, and comprehensive wound care. This review will help the doctors and healthcare providers involved in the management of critical burn patients in their day-today practice.
World Journal of Surgery, 1992
The goal of fluid resuscitation in the burn patient is maintenance of vital organ function at the least immediate or delayed physiological cost. To optimize fluid resuscitation in severely burned patients, the amount of fluid should be just enough to maintain vital organ function without producing iatrogeuic pathological changes. The composition of the resuscitation fluid in the first 24 hours postburn probably makes very little difference; however, it should be individualized to the particular patient. The utilization of the advantages of hypertonic, crystalloid, and colloid solutions at various times postburn will minimize the amount of edema formation. The rate of administration of resuscitation fluids should be that necessary to maintain satisfactory organ function, with maintenance of hourly urine outputs of 30 cc to 50 cc in adults and 1-2 ce/kg/% burn in children. When a child reaches 30 kg to 50 kg in weight, the urine output should he maintained at the adult level. With our current knowledge of the massive fluid shifts and vascular changes that occur, mortality related to burn-induced hypovolemia has decreased considerably. The failure rate for adequate initial volume restoration is less than 5% even for patients with burns of more than 85% of the total body surface area. These improved statistics, however, are derived from experience in burn centers, where there is substantial knowledge of the pathophysiology of burn injury. Inadequate volume replacement in major burns is, unfortunately, common when clinicians lack sufficient knowledge in this area.
Managing Burns and Related Complications in Emergency
2019
A burn is a thermal injury caused by biological, chemical, electrical and physical agents with local and systemic repercussions. They have a greater incidence in economically and culturally marginalized countries. Knowing the kind of burn is vital for effective management. Following a burn, there's a huge production of free radicals that is harmful and involved in inflammation, systemic inflammatory response syndrome, immunosuppression, infection and sepsis, tissue injury and multiple organ failure. The aim of first aid is cessation of the burning process, cool the burn,(relieve the pain),and cover the burn. Treatment with cutaneous grafts focuses on avoiding granulation phase where there is contraction of wound. The definitive treatment of burns is tangential excision and early grafting, since they are the only measures that decrease the metabolic demand, infections, hospital stay and morbidity. Basic science studies have slowly begun to uncover the complex mechanisms involved ...
Management of severe thermal burns in the acute phase in adults and children
Anaesth Crit Care Pain Med, 2020
Objectives: To provide recommendations to facilitate the management of severe thermal burns during the acute phase in adults and children. Design: A committee of 20 experts was asked to produce recommendations in six fields of burn management, namely, (1) assessment, admission to specialised burns centres, and telemedicine; (2) haemodynamic management; (3) airway management and smoke inhalation; (4) anaesthesia and analgesia; (5) burn wound treatments; and (6) other treatments. At the start of the recommendation- formulation process, a formal conflict-of-interest policy was developed and enforced throughout the process. The entire process was conducted independently of any industry funding. The experts drew up a list of questions that were formulated according to the PICO model (Population, Intervention, Comparison, and Outcomes). Two bibliography experts per field analysed the literature published from January 2000 onwards using predefined keywords according to PRISMA recommendations. The quality of data from the selected literature was assessed using GRADE1 methodology. Due to the current paucity of sufficiently powered studies regarding hard outcomes (i.e. mortality), the recommendations are based on expert opinion. Results: The SFAR guidelines panel generated 24 statements regarding the management of acute burn injuries in adults and children. After two scoring rounds and one amendment, strong agreement was reached for all recommendations. Conclusion: Substantial agreement was reached among a large cohort of experts regarding numerous strong recommendations to optimise the management of acute burn injuries in adults and children.
A 10-year experience with major burns from a non-burn intensive care unit
Burns, 2014
Major burns are injuries with necrosis at the epidermis and the dermis, resulting from thermic, chemical, electric or radiation exposure , with children and the elderly being the most affected . Although scalding injury is the most common mechanism of injury in adults at emergency departments, direct fire is the most common mechanism in hospitalised cases, especially in men, which is associated with greater mortality . The main risk factors associated with mortality identified so far are age, inhalation injury and total burn surface area (%TBSA) . Age contributes significantly to mortality, as survival in most paediatric population series is around 90-100%. Airway injury is reported in up to 43% of all hospitalised patients with major burns, giving an 8-10-fold risk of death . In addition, there is a marked correlation between %TBSA and death rising considerably from >20% TBSA . In a systematic review with >186,500 patients in Europe, Brusselaers reports a mortality rate from 1.4% to 18% (maximum 34%) in major burn patients ; however, much of these data come from reference centres, patients with a mean %TBSA between 11% and 24%, with less strict admission criteria, and patients not necessarily critically ill. On the other b u r n s x x x ( 2 0 1 4 ) x x x -x x x
Burn injury: review of pathophysiology and therapeutic modalities in major burns
Annals of burns and fire disasters, 2017
Despite a considerable decrease in their incidence worldwide, burn injuries remain one of the commonest forms of trauma and account for a weighty proportion of trauma cases in health-care emergencies around the globe. Although the latest data reveal a substantial decline in burn-related mortality and hospital admissions in the US over the past three decades, severe thermal injuries continue to trigger devastating morbidity and significant mortality while their management remains a dynamic challenge for the entire medical and paramedical community. Concrete evidence continues to be established regarding burn-associated pathophysiologic responses, and their destructive sequelae and deleterious effects in survivors at cellular, systemic as well as socio-economic level. Better understanding of these responses have contributed to advances in therapeutic strategies, improved long-term outcomes and catalyzed the reintegration of victims back into society. This paper describes the current u...