Korean J Crit Care Med.  2017 Feb;32(1):9-21. 10.4266/kjccm.2016.00969.

Management of Critical Burn Injuries: Recent Developments

• Dries DJ
• Marini JJ

• KMID: 2371149
• DOI: http://doi.org/10.4266/kjccm.2016.00969

Abstract

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.

Keyword

burns; electrical injuries; infection; lightning; resuscitation; smoke inhalation injury

MeSH Terms

Burn Units
Burns*
Humans
Inhalation
Lightning
Renal Insufficiency
Resuscitation
Smoke Inhalation Injury
Wound Healing

Figure

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  Figure 1. Protocol for fluid resuscitation of adult burn patients. In response to requests from nurses, this protocol was developed to permit nursing staff to manage fluid resuscitation of acute burn patients. Initial fluid rates are calculated by the Parkland formula. Nurses begin hourly infusion, measure urine output, and adjust fluids according to patient response. Development of unstable vital signs, inadequate response to fluids, or persistently high fluid requirements prompt a call to the physician. A pathway to begin colloid replacement exists for patients who display increasing fluid requirements or develop symptoms of torso compartment syndrome. Adopted from references [3]. with permission. LR: lactated Ringer’s solution; D5: 5% dextrose.

Reference

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