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Organ responses and organ support

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Handbook of Burns

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Abstract

Over the past fifty years, goal-directed resuscitation [1–3], early burn wound excision and grafting [4–7], and recognition of burn hypercatabolism [8–10] have dramatically reduced mortality rates after burn injury [11–15]. Despite this progress, end-organ dysfunction remains a threat throughout a patient’s clinical course. Recent studies approximate the incidence of multiple organ dysfunction as 40–60 % among patients with greater than 20 % total body surface area (TBSA) burns, with associated mortality rates from 22–100 % [16–19]. These mortality rates increase in proportion to the number of failed systems [19]. The link between multi-organ failure and patient mortality highlights the necessity for practitioners to cultivate an understanding of burn pathophysiology, as well as critical care principles of organ support.

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References

  1. Ipaktchi K, Arbabi S (2006) Advances in burn critical care. Crit Care Med 34[9 Suppl]: S239–244

    Article  PubMed  Google Scholar 

  2. Saffle JI (2007) The phenomenon of “fluid creep” in acute burn resuscitation. J Burn Care Res 28(3): 382–395

    Article  PubMed  Google Scholar 

  3. Salinas J, Drew G, Gallagher J, Cancio LC, Wolf SE et al (2008) Closed-loop and decision-assist resuscitation of burn patients. J Trauma 64[4 Suppl]: S321–332

    Article  Google Scholar 

  4. Tompkins RG, Remensnyder JP, Burke JF, Tompkins DM, Hilton JF et al (1988) Significant reductions in mortality for children with burn injuries through the use of prompt eschar excision. Ann Surg 208(5): 577–585

    Article  PubMed  CAS  Google Scholar 

  5. Herndon DN, Barrow RE, Rutan RL, Rutan TC, Desai MH et al (1989) A comparison of conservative versus early excision. Therapies in severely burned patients. Ann Surg 209(5): 547–552; discussion 552-543

    Article  PubMed  CAS  Google Scholar 

  6. Xiao-Wu W, Herndon DN, Spies M, Sanford AP, Wolf SE (2002) Effects of delayed wound excision and grafting in severely burned children. Arch Surg 137(9): 1049–1054

    Article  PubMed  Google Scholar 

  7. Ong YS, Samuel M, Song C (2006) Meta-analysis of early excision of burns. Burns 32(2): 145–150

    Article  PubMed  Google Scholar 

  8. Pereira C, Murphy K, Jeschke M, Herndon DN (2005) Post burn muscle wasting and the effects of treatments. Int J Biochem Cell Biol 37(10): 1948–1961

    Article  PubMed  CAS  Google Scholar 

  9. Pereira CT, Herndon DN (2005) The pharmacologic modulation of the hypermetabolic response to burns. Adv Surg 39: 245–261

    Article  PubMed  Google Scholar 

  10. Branski LK, Herndon DN, Barrow RE, Kulp GA, Klein GL et al (2009) Randomized controlled trial to determine the efficacy of long-term growth hormone treatment in severely burned children. Ann Surg n:n–n

    Google Scholar 

  11. O’Keefe GE, Hunt JL, Purdue GF (2001) An evaluation of risk factors for mortality after burn trauma and the identification of gender-dependent differences in outcomes. J Am Coll Surg 192(2): 153–160

    Article  PubMed  Google Scholar 

  12. White CE, Renz EM (2008) Advances in surgical care: management of severe burn injury. Crit Care Med 36[7 Suppl]: S318–324

    Article  Google Scholar 

  13. Fratianne RB, Brandt CP (1997) Improved survival of adults with extensive burns. J Burn Care Rehabil 18: 347–351

    Article  PubMed  CAS  Google Scholar 

  14. Curreri PW, Luterman A, Braun DW, Shires GT (1980) Burn injury-analysis of survival and hospitalization time for 937 patients. Ann Surg 82: 472–478

    Article  Google Scholar 

  15. McGwin G, Cross JM, Ford JW, Rue LW (2003) Longterm trends in mortality according to age among adult burn patients. J Burn Care Rehab 24(1): 21–25

    Article  Google Scholar 

  16. Marshall WG, Dimick AR (1983) The natural history of major burns with multiple subsystem failure. J Trauma 23: 102–105

    Article  PubMed  Google Scholar 

  17. Sheridan RL, Ryan CM, Yin LM, Hurley J, Tompkins RG (1998) Death in the burn unit: sterile multiple organ failure. Burns 24: 307–311

    Article  PubMed  CAS  Google Scholar 

  18. Cumming J, Purdue GF, Hung JL, O’Keefe GE (2001) Objective estimates of the incidence and consequences of multiple organ dysfunction and sepsis after burn trauma. J Trauma 50(3): 510–515

    Article  PubMed  CAS  Google Scholar 

  19. Nguyen LN, Nguyen TG (2009) Characteristics and outcomes of multiple organ dysfunction syndrome among severe-burn patients. Burns 35(7): 937–941

    Article  PubMed  Google Scholar 

  20. Pham TN, Cancio LC, Gibran NS (2008) American Burn Association practice guidelines: Burn shock resuscitation. J Burn Care Res 29(1): 257–266

    PubMed  Google Scholar 

  21. Wolf SE, Herndon DN (2004) Burns. Sabiston textbook of surgery: The biological basis of modern surgical practice, 17th edn. npublisher,nplace of publication, pp 569–596

    Google Scholar 

  22. Dehne MG, Sablotzki A, Hoffmann A, Muhling J, Dietrich FE, Hempelmann G (2002) Alterations of acute phase reaction and cytokine production in patients following severe burn injury. Burns 28: 535–542

    Article  PubMed  Google Scholar 

  23. Tricklebank S (2009) Modern trends in fluid therapy for burns. Burns 35(6): 757–767

    Article  PubMed  Google Scholar 

  24. Latenser BA (2009) Critical care of the burn patient: the first 48 hours. Crit Care Med 37: 2819–2826

    Article  PubMed  CAS  Google Scholar 

  25. Barret JP, Herndon DN (2003) Modulation of inflammatory and catabolic responses in severely burned children by early burn wound excision in the first 24 h. Arch Surg 138: 127–132

    Article  PubMed  Google Scholar 

  26. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. NEJM 345: 1368–1377

    Article  PubMed  CAS  Google Scholar 

  27. Dellinger RP, Levy MM, Carlet JM, Blon J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale RE, Calandra T, Dhalnaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson T, Townsend S, Vender JS, Zimmerman JL, Vincent JL (2008) Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 36: 296–327

    Article  PubMed  Google Scholar 

  28. Cancio LC, Galvez E, Turner CE (2006) Base deficit and alveolar-arterial gradient during resuscitation contribute independently but modestly to the prediction of mortality after burn injury. J Burn Care Res 27: 289–296

    Article  PubMed  Google Scholar 

  29. Kamolz LP, Andel H, Schramm W (2005) Lactate: early predictor of morbidity and mortality in patients with severe burns. Burns 31: 986–990

    Article  PubMed  Google Scholar 

  30. Jeng JC, Lee K, Jablonski K (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: 402–405

    Article  PubMed  CAS  Google Scholar 

  31. Andel D, Kamolz LP, Roka J, Schramm W, Zimpfer M, Frey M, Andel H (2007) Base deficit and lactate: Early predictors of morbidity and mortality in patients with burns. Burns 33(8): 973–978

    Article  PubMed  CAS  Google Scholar 

  32. Conway DH, Mayall R, Abdul-Latif MS, Gilligan S, Tackaberry C (2002) Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery. Anaesthesia 57: 845–849

    Article  PubMed  CAS  Google Scholar 

  33. Gan TJ, Sopitt A, Maroof M, El-Moalem H, Robertson KM, Moretti E (2002) Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 97: 820–826

    Article  PubMed  Google Scholar 

  34. Yamamoto Y, Nozaki M, Nozaki T, Higashimori H, Nakazawa H (2007) Clinical evaluation of the echo-esophageal Doppler for the cardiac output monitoring of patients with extensive burns. Burns 33: S38–S39

    Article  Google Scholar 

  35. Holm C, Mayr M, Tegeler J, Horbrand F, Henckel von Donnersmarck G, Muhlbauer W, Pfeiffer UJ (2004) A clinical randomized study on the effects of invasive monitoring on burn shock resuscitation. Burns 30: 798–807

    Article  PubMed  CAS  Google Scholar 

  36. Saffle JR (2007) The phenomenon of “fluid creep” in acute burn resuscitation. J Burn Care Res 28: 382–395

    Article  PubMed  Google Scholar 

  37. Alam HB, Rhee P (2007) New developments in fluid resuscitation. Surg Clin North Am 87(1): 55–72

    Article  PubMed  Google Scholar 

  38. Klein MB, Hayden D, Elson C, Nathens AB, Gamelli RL, Gibran NS, Herndon DN, Arnoldo B, Silver G, Schoenfeld D, Tompkins RG (2007) The association between fluid administration and outcome following major burn: A multicenter study. Ann Surg 245(4): 622–628

    Article  PubMed  Google Scholar 

  39. Ivy ME, Atweh NA, Palmer J (2000) Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma 49: 387–391

    Article  PubMed  CAS  Google Scholar 

  40. O’Mara MS, Slater H, Goldfarb IW, Caushaj PF (2005) A prospective, randomized evaluation of intra-abdominal pressures with crystalloid and colloid resuscitation in burn patients. J Trauma 58: 1011–1018

    Article  PubMed  Google Scholar 

  41. Chung KK, Blackbourne LH, Wolfe SE (2006) Evolution of burn resuscitation in operation Iraqi freedom. J Burn Care Res 27: 606–611

    Article  PubMed  Google Scholar 

  42. The SAFE Study Investigators (2004) A comparison of albumin and saline for fluid resuscitation in the intensive care unit. NEJM 350: 2247–2256.

    Article  Google Scholar 

  43. Tanaka H, Matsuda T, Miyagantani Y, Yukioka T, Matsuda H, Shimazaki S (2000) Reduction of resuscitation fluid volumes in severely burned patients using ascorbic acid administration. Arch Surg 135: 326–331

    Article  PubMed  CAS  Google Scholar 

  44. Hart DW, Wolf SE, Mlcak R (2000) Persistence of muscle catabolism after severe burn. Surgery 128: 312–319

    Article  PubMed  CAS  Google Scholar 

  45. Hart DW, Wolfe SE, Herndon DN (2002) Energy expenditure and caloric balance after burn: Increased feeding leads to fat rather than lean mass accretion. Ann Surg 235: 152–161

    Article  PubMed  Google Scholar 

  46. Hart DW, Wolf SE, Chinkes DL (2000) Determinants of skeletal muscle catabolism after severe burn. Ann Surg 232: 455–465

    Article  PubMed  CAS  Google Scholar 

  47. Hart DW, Wolf SE, Chinkes DL (2003) Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after severe burn. J Trauma 54: 755–761

    Article  PubMed  CAS  Google Scholar 

  48. Herndon DN, Tompkins RG (2004) Support of the metabolic response to burn injury. Lancet 363: 1895–1902

    Article  PubMed  CAS  Google Scholar 

  49. Herndon DN, Hart DW, Wolf SE (2001) Reversal of catabolism by beta-blockade after severe burns. NEJM 345: 1223–1229

    Article  PubMed  CAS  Google Scholar 

  50. Arbabi S, Ahrns KS, Wahl WL (2004) Beta-blocker use is associated with improved outcomes in adult burn patients. J Trauma 56: 265–269

    Article  PubMed  CAS  Google Scholar 

  51. Hart DW, Wolf SE, Ramzy PI (2001) Anabolic effects of oxandrolone after severe burn. Ann Surg 233: 556–564

    Article  PubMed  CAS  Google Scholar 

  52. Demling RH, Orgill DP (2000) The anticatabolic and wound healing effects of the testosterone analog oxandrolone after severe burn injury. J Crit Care 15: 12–17

    Article  PubMed  CAS  Google Scholar 

  53. Wolf SE, Edelman LS, Mealyan N (2006) Effects of oxandrolone on outcome measures in the severely burned: A multicenter prospective randomized double-blind trial. J Burn Care Res 27: 131–139

    Article  PubMed  Google Scholar 

  54. Flierl MA, Stahel PF, Touban BM, Beauchamp KM, Morgan SJ, Smith WR, Ipaktchi KR (2009) Bench-tobedside review: Burn-induced cerebral inflammation — a neglected entity? Crit Care 13(3): 215

    Article  PubMed  Google Scholar 

  55. Girard TD, Kress JP, Fuchs BD, Thomason JWW, Schweickert WD, Bun BT, Taichman DB, Dunn JG, Pohlman AS, Kinniry PA, Jackson JC, Canonico AE, Light RW, Shintani AK, Thompson JL, Gordon SM, Hall JB, Dittus RS, Bernard GR, Ely EW (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomized controlled trial. Lancet 371(9607): 126–134

    Article  PubMed  Google Scholar 

  56. Prockop LD, Chickova RI (2007) Carbon monoxide intoxication: An updated review. J Neuro Sci 262: 122–130

    Article  CAS  Google Scholar 

  57. Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G (2008) Clinical review: Critical illness polyneuropathy and myopathy. Crit Care 12(6): 238–247

    Article  PubMed  Google Scholar 

  58. Peck MD, Koppelman T (2009) Low-tidal volume ventilation as a strategy to reduce ventilator-associated injury in ALI and ARDS. J Burn Care Res 30: 172–183

    Article  PubMed  Google Scholar 

  59. Mosier MJ, Pham TN (2009) American Burn Association practice guidelines for prevention, diagnosis, and treatment of ventilator-associated pneumonia (VAP) in burn patients. J Burn Care Res 30: 910–928

    PubMed  Google Scholar 

  60. Dancey DR, Hayes J, Gomez M (1999) ARDS in patients with thermal injury. Int Care Med 25: 1231–1236

    Article  CAS  Google Scholar 

  61. Allen K, Bigatello L (2010) The Acute Respiratory Distress Syndrome. Critical Care Handbook of the Massachusetts General Hospital, 5th edn. npublisher, nplace of publication, pp 288–298

    Google Scholar 

  62. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome: The Acute Respiratory Distress Syndrome Network. NEJM (2000) 342: 1301–1308

    Article  Google Scholar 

  63. Cartotto R, Ellis S, Smith T (2005) Use of high-frequency oscillatory ventilation in burn patients. Crit Care Med 33[Suppl 3]: S175–S181

    Article  PubMed  Google Scholar 

  64. Wahl WL, Ahrns KS, Brandt MM (2005) Bronchoalveolar lavage in diagnosis of ventilator-associated pneumonia in patients with burns. J Burn Care Rehabil 26: 57–61

    Article  PubMed  Google Scholar 

  65. Croce MA, Fabian TC, Mueller EW (2004) The appropriate diagnostic threshold for ventilator-associated pneumonia using quantitative cultures. J Trauma 56: 931–934

    Article  PubMed  Google Scholar 

  66. Fagon JY, Chastre J, Woff M (2000) Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia: a randomized trial. Ann Intern Med 132: 621–630

    PubMed  CAS  Google Scholar 

  67. Brusselaers N, Monstrey S, Colpaert K, Decruenaere J, Blot SI, Hoste EAJ (2010) Outcome of acute kidney injury in severe burns: a systematic review and metaanalysis. Int Care Med 365: 915–925

    Article  Google Scholar 

  68. Mosier MJ, Pham TN, Klein MB, Gibran NS, Arnoldo BD, Gamelli RL, Tompkins RG, Herndon DN (2010) Early acute kidney injury predicts progressive renal dysfunction and higher mortality in severely burned adults. J Burn Care Res 31: 83–92

    Article  PubMed  Google Scholar 

  69. Dennen P, Douglas IS, Anderson R (2010) Acute kidney injury in the intensive care unit: An update and primer for the intensivist. Crit Care Med 38: 261–275

    Article  PubMed  Google Scholar 

  70. Morellia A, Ricci Z, Bellomo R (2005) Prophylactic fenoldepam for renal protection in sepsis: A randomized, double-blind, placebo-controlled pilot trial. Crit Care Med 33: 2451–2456

    Article  Google Scholar 

  71. Landoni G, Biondi-Zoccai GG, Tumlin JA (2007) Beneficial impact of fenoldepam in critically ill patients with or at risk for acute renal failure: a meta-analysis of randomized clinical trials. Am J Kidney Dis 49: 56–68

    Article  PubMed  CAS  Google Scholar 

  72. Magnotti LJ, Deitch EA (2005) Burns, bacterial translocation, gut barrier function, and failure. J Burn Care Rehabil 26: 383–391

    Article  PubMed  Google Scholar 

  73. Deitch EA (1990) Intestinal permeability is increased in burn patients shortly after injury. Surgery 107: 411–416

    PubMed  CAS  Google Scholar 

  74. Ryan CM, Yarmush ML, Burke JF (1992) Increased gut permeability early after burns correlates with the extent of burn injury. Crit Care Med 20: 1508–1512

    Article  PubMed  CAS  Google Scholar 

  75. LeVoyer T, Cioffi WG, Pratt L (1992) Alterations in intestinal permeability after severe thermal injury. Arch Surg 127: 26–29

    Article  PubMed  CAS  Google Scholar 

  76. Andel H, Rab M, Andel D (2001) Impact of early high caloric duodenal feeding on the oxygen balance of the splanchnic region after severe burn injury. Burns 27: 389–393

    Article  PubMed  CAS  Google Scholar 

  77. Herndon DN, Barrow RE, Stein M (1989) Increased mortality with intravenous supplemental feeding in severely burned patients. J Burn Care Rehabil 10: 309–313

    Article  PubMed  CAS  Google Scholar 

  78. Alexander JW, MacMillan BG, Stinnett JD (1980) Beneficial effects of aggressive protein feeding in severely burned children. Ann Surg 192: 505–517

    Article  PubMed  CAS  Google Scholar 

  79. Sugiura T, Tashiro T, Yamamori H, Takagi K, Hayashi N, Itahashi T (1999) Effects of total parenteral nutrition on endotoxin translocation and extent of the stress response in burned rats. Nutrition 15: 570–575

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Shriners Hospital for Children, Massachusetts General Hospital, Harvard Medical School, 51 Blossom Street, Boston, MA, 02114, USA

    Kathryn L. Butler & Robert L. Sheridan

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  1. Kathryn L. Butler
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  2. Robert L. Sheridan
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Correspondence to Robert L. Sheridan .

Editor information

Editors and Affiliations

  1. Sunnybrook Health Sciences Centre, Department of Surgery, Division of Plastic Surgery, University of Toronto, Sunnybrook Research Institute, Toronto, ON, Canada

    Marc G. Jeschke M.D., Ph.D.

  2. Plastische, Aesthetische und Rekonstruktive Chirurgie, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria

    Lars-Peter Kamolz M.D., M.Sc.

  3. Department of Hand and Plastic Surgery and Intensive Care, Linköping University Hospital, Linköping, Sweden

    Folke Sjöberg M.D., Ph.D.

  4. Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden

    Folke Sjöberg M.D., Ph.D.

  5. Brooke Army Medical Center, Fort Sam Houston, TX, USA

    Steven E. Wolf M.D.

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Butler, K.L., Sheridan, R.L. (2012). Organ responses and organ support. In: Jeschke, M.G., Kamolz, LP., Sjöberg, F., Wolf, S.E. (eds) Handbook of Burns. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0348-7_13

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