Perioperative Management of the Severely Burned Patient

  • E. R. Sherwood
  • L. C. Woodson

Abstract

Burn care has improved markedly since the end of World War II. Important innovations include aggressive fluid resuscitation, early excision and grafting of burn wounds, more effective antibiotics, advances in enteral nutritional support and the development of multidisciplinary burn centers. Most patients with burns involving 80% or more of the total body surface area will survive if promptly treated. A recent study identified three risk factors that are predictive of increased mortality following thermal injury: age greater than 60 years, burns over more than 40% of the total body surface area, and the presence of inhalation injury [1]. Mortality increased in proportion to the number of risk factors present. Significant coexisting disease or delays in resuscitation also increased the mortality rate.

Keywords

Acute Renal Failure Fluid Resuscitation Airway Management Laryngeal Mask Airway Thermal Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Ryan CM, Schoenfeld DA, Thorpe WP, Sheridan RL, Cassem EH, Tompkins RG (1998) Objective estimates of the probability of death from burn injuries. N Engl J Med 338: 362–366PubMedCrossRefGoogle Scholar
  2. 2.
    Reynolds EM, Ryan DP, Sheridan RL, Doody DP (1995) Left ventricular failure complicating severe pediatric burn injuries. J Pediatr Surg 30: 264–269PubMedCrossRefGoogle Scholar
  3. 3.
    Desai MH, Herndon DN, Broemeling L, Barrow RE, Nichols RJ, Rutan RL (1990) Early burn wound excision significantly reduces blood loss. Ann Surg 211: 753–759PubMedCrossRefGoogle Scholar
  4. 4.
    Thompson PB, Herndon DN, Traber DL, Abston S (1986) Effect on mortality of inhalation injury. J Trauma 26: 163–165PubMedCrossRefGoogle Scholar
  5. 5.
    Navar PD, Saffle JR, Warden GD (1985) Effect of inhalation injury on fluid resuscitation requirements after thermal injury. Am J Surg 150: 716–720PubMedCrossRefGoogle Scholar
  6. 6.
    Hollingsed TC, Saffle JR, Barton RG, Craft WB, Morris SE (1993) Etiology and consequences of respiratory failure in thermally injured patients. Am J Surg 166: 592–597PubMedCrossRefGoogle Scholar
  7. 7.
    Foley FD (1969) The burn autopsy. Am J Clin Path 52: 1–13PubMedGoogle Scholar
  8. 8.
    Ernst A, Zibrak JD (1998) Carbon monoxide poisoning. N Engl J Med 339: 1603–1608PubMedCrossRefGoogle Scholar
  9. 9.
    Tibbles P, Perrotta P (1994) Treatment of carbon monoxide poisoning: A critical review of human outcome studies comparing normobaric oxygen with hyperbaric oxygen. Ann Emerg Med 24: 269–276Google Scholar
  10. 10.
    Clark CJ (1982) Measurement of toxic combustion products in fire survivors. J Royal Soc Med 153: 41–44Google Scholar
  11. 11.
    Hu OY, Ho ST, Wang JJ, Lin CY (1993) Evaluation of gastric emptying in severe, burn-injured patients. Crit Care Med 21: 527–531PubMedCrossRefGoogle Scholar
  12. 12.
    Mathru M, Esch O, Lang J, et al (1996) Magnetic resonance imaging of the upper airway: Effects of propofol anesthesia and nasal continuous positive airway pressure in humans. Anesthesiology 84: 275–278Google Scholar
  13. 13.
    Lang J, Herbert M, Esch, Chaljuh G, Mathru M (1997) Magnetic resonance of the upper airway: Ketamine preserves airway potency compared to propofol anesthesia in human volunteers. Anesth Ana1g 84: 542 (Abst)Google Scholar
  14. 14.
    McCall VE, Fischer CG, Schomaker E, Young VM (1999) Laryngeal mask airway use in children with acute burns: intraoperative airway management. Paediatr Anaesth 9: 515–520PubMedCrossRefGoogle Scholar
  15. 15.
    Deitch EA (1990) The management of burns. N Engl J Med 323: 1249–1253PubMedCrossRefGoogle Scholar
  16. 16.
    Horton JW, Baxter CR, White DJ (1989) Differences in cardiac responses to resuscitation from burn shock. Surg Gynecol Obstet 168: 201–213PubMedGoogle Scholar
  17. 17.
    Muller-Werdan U, Engelmann H, Werdan K (1998) Cardiodepression by tumor necrosis factor-alpha. Eur Cytokine Netw 9: 689–691PubMedGoogle Scholar
  18. 18.
    Alderson P, Schierhout G, Roberts I, Bunn F (2000) Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2:CD000567Google Scholar
  19. 19.
    The Albumin Reviewers (2000) In: Alderson P, Bunn F, Lefebvre C, Li Wan Po A, Li L, Roberts I, Schierhout G (ed) Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database Syst Rev 2:CD001208Google Scholar
  20. 20.
    Guha SC, Kinsky MP, Button B, et al (1996) Burn resuscitation: crystalloid versus colloid versus hypertonic saline hyperoncotic colloid in sheep. Crit Care Med 24: 1849–1857PubMedCrossRefGoogle Scholar
  21. 21.
    Elgjo GI, Poli de Figueiredo LF, Schenarts PJ, Traber DL, Traber LD, Kramer GC (2000) Hypertonic saline dextran produces early (8–12 hrs) fluid sparing in burn resuscitation: a 24-hr prospective, double-blind study in sheep. Crit Care Med 28: 163–171PubMedCrossRefGoogle Scholar
  22. 22.
    Suzuki K, Ogino R, Nishina M, Kohama A (1995) Effects of hypertonic saline and dextran cardiac functions after burns. Am J Physiol 268: H856–H864PubMedGoogle Scholar
  23. 23.
    Jeng JC, Lee K, Jablonski K, Jordan MH (1997) Serum lactate and base deficit suggest inadequate resuscitation of patients with burn injuries: application of a point-of-care laboratory instrument. J Burn Care Rehabil 18: 402–405PubMedCrossRefGoogle Scholar
  24. 24.
    Dries DJ, Waxman K (1991) Adequate resuscitation of burn patients may not be measured by urine output and vital signs. Crit Care Med 19: 327–329PubMedCrossRefGoogle Scholar
  25. 25.
    Porter JM, Ivatury RR (1998) In search of the optimal end points of resuscitation in trauma patients: a review. J Trauma 44: 908–914PubMedCrossRefGoogle Scholar
  26. 26.
    Holm C, Melcer B, Horbrand F, Worl HH, von Donnersmarck GH, Muhlbauer W (2000) Haemodynamic and oxygen transport responses in survivors and non-survivors following thermal injury. Burns 26: 25–33PubMedCrossRefGoogle Scholar
  27. 27.
    Kaups KL, Davis JW, Dominic WJ (1998) Base deficit as an indicator or resuscitation needs in patients with burn injuries. J Burn Care Rehabil 19: 346–348PubMedCrossRefGoogle Scholar
  28. 28.
    Schiller WR, Bay RC, Garren RL, Parker I, Sagraves SG (1997) Hyperdynamic resuscitation improves survival in patients with life-threatening burns. J Burn Care Rehabil 18: 10–16PubMedCrossRefGoogle Scholar
  29. 29.
    Holm C, Melcer B, Horbrand F, von Donnersmarck GH, Muhlbauer W (2000) The relationship between oxygen delivery and oxygen consumption during fluid resuscitation of burn-related shock. J Burn Care Rehabil 21: 147–154PubMedCrossRefGoogle Scholar
  30. 30.
    Bernard F, Gueugniaud PY, Bertin-Maghit M, Bouchard C, Vilasco B, Petit P (1994) Prognostic significance of early cardiac index measurements in severely burned patients. Burns 20: 529–531PubMedCrossRefGoogle Scholar
  31. 31.
    Bishop MH, Shoemaker WC, Appel PL, et al (1995) Prospective, randomized trial of survivor values of cardiac index, oxygen delivery, and oxygen consumption as resuscitation endpoints in severe trauma. J Trauma 38: 780–787PubMedCrossRefGoogle Scholar
  32. 32.
    Fleming A, Bishop M, Shoemaker W, et al (1992) Prospective trial of supranormal values as goals of resuscitation in severe trauma. Arch Surg 127: 1175–1179PubMedCrossRefGoogle Scholar
  33. 33.
    Schiller WR, Bay RC, Garren RL, Parker I, Sagraves SG (1997) Hyperdynamic resuscitation improves survival in patients with life-threatening burns. J Burn Care Rehabil 18: 10–16PubMedCrossRefGoogle Scholar
  34. 34.
    Heyland DK, Cook DJ, King D, Kernerman P, Brun-Buisson C (1996) Maximizing oxygen delivery in critically ill patients: a methodologic appraisal of the evidence. Grit Care Med 24: 517–524CrossRefGoogle Scholar
  35. 35.
    Gattinoni L, Brazzi L, Pelosi P, et al (1995) A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 Collaborative Group. N Engl J Med 333: 1025–1032PubMedCrossRefGoogle Scholar
  36. 36.
    Durham RM, Neunaber K, Mazuski JE, Shapiro MJ, Baue AE (1996) The use of oxygen consumption and delivery as endpoints for resuscitation in critically ill patients. J Trauma 41: 32–39PubMedCrossRefGoogle Scholar
  37. 37.
    Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med. 330: 1717–1722PubMedCrossRefGoogle Scholar
  38. 38.
    Mann R, Heimbach DM, Engrav LH, Foy H (1994) Changes in transfusion practices in burn patients. J Trauma 37: 220–222PubMedCrossRefGoogle Scholar
  39. 39.
    Sittig KM, Deitch EA (1994) Blood transfusions: for the thermally injured or for the doctor? J Trauma 36: 369–372PubMedCrossRefGoogle Scholar
  40. 40.
    Davies DM, Pusey CD, Rainford DJ, Brown JM, Bennett JP (1979) Acute renal failure in burns. Scand J Plast Reconstr Surg 13: 189–192PubMedCrossRefGoogle Scholar
  41. 41.
    Holm C, Horbrand F, von Donnersmarck GH, Muhlbauer W (1999) Acute renal failure in severely burned patients. Burns 25: 171–178PubMedCrossRefGoogle Scholar
  42. 42.
    Jeschke MG, Barrow RE, Wolf SE, Herndon DN (1998) Mortality in burned children with acute renal failure. Arch Surg 133: 752–756PubMedCrossRefGoogle Scholar
  43. 43.
    Wallace BH, Caldwell FT Jr, Cone JB (1994) The interrelationships between wound management, thermal stress, energy metabolism, and temperature profiles of patients with burns. J Burn Care Rehabil 15: 499–508PubMedCrossRefGoogle Scholar
  44. 44.
    Caldwell FT Jr, Wallace BH, Cone JB (1994) The effect of wound management on the interaction of burn size, heat production, and rectal temperature. J Burn Care Rehabil 15: 121–129PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • E. R. Sherwood
  • L. C. Woodson

There are no affiliations available

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