Advertisement

Critical care of thermally injured patient

  • Mette M. Berger
  • Shahriar Shahrokhi
  • Marc G. Jeschke

Abstract

Only a minority of burn injured patients will require intensive care unit (ICU) admission and treatment. A burn is considered “major” when involving more than 20 % BSA, with further severity steps at 40 % and 60 % TBSA, the later being called massive burn injury. The presence of inhalation injury will have further additive affects increasing the mortality. Major burns impact the function of all organs: the massive release of pro-inflammatory mediators and lipid peroxides by the thermally injured skin will induce oxidative stress and inflammatory responses, which in turn cause cardiovascular, respiratory, digestive, renal, endocrine, and metabolic alterations. All these responses are proportional to the severity of the injury. Age and presence of co-morbidities are important prognostic factors, even more than in any other critical care condition. The massively burned patient poses one of the greatest challenges in critical care.

Keywords

Ischemia Pneumonia Cortisol Immobiliz Ation Estradiol 
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.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. [1]
    Agay D, Sandre C, Ducros V et al (2005) Optimization of selenium status by a single intra-peritoneal injection of Se in Se deficient rat: possible application to burned patient treatment. Free Rad Biol Med 39(6): 762–768PubMedCrossRefGoogle Scholar
  2. [2]
    Alderson P, Bunn F, Lefebvre C et al (2004) Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database Syst Rev 2004(4):CD001 208Google Scholar
  3. [3]
    Alvarado R, Chung KK, Cancio LC et al (2009) Burn resuscitation. Burns 35(1): 4–14PubMedCrossRefGoogle Scholar
  4. [4]
    Arbabi S, Ahrns KS, Wahl WL et al (2004) Beta-blocker use is associated with improved outcomes in adult burn patients. J Trauma 56(2): 265–269; discussion 269-271PubMedCrossRefGoogle Scholar
  5. [5]
    Arlati S, Storti E, Pradella V et al (2007) Decreased fluid volume to reduce organ damage: a new approach to burn shock resuscitation? A preliminary study. Resuscitation 72(3): 371–378PubMedCrossRefGoogle Scholar
  6. [6]
    Arturson G, Jakobsson OP (1985) Oedema measurements in a standard burn model. Burns 12: 1–7CrossRefGoogle Scholar
  7. [7]
    Arturson G, Bode G, Brizio-Molteni L et al (1990) Endocrinology of thermal trauma. Lea & Febiger, LondonGoogle Scholar
  8. [8]
    Ballian N, Rabiee A, Andersen DK et al (2010) Glucose metabolism in burn patients: The role of insulin and other endocrine hormones. Burns;e-pub:Jan 12Google Scholar
  9. [9]
    Barillo DJ, Goode R, Esch V (1994) Cyanide poisoning in victims of fire: analysis of 364 cases and review of the literature. J Burn Care Rehabil 15: 46–57PubMedCrossRefGoogle Scholar
  10. [10]
    Belmonte Torras JA, Marin de la Cruz D, Sune Garcia JM et al (2006) [Burns produced by lighters]. An Pediatr (Barc) 64(5): 468–473CrossRefGoogle Scholar
  11. [11]
    Berger MM, Rothen C, Cavadini C et al (1997) Exudative mineral losses after serious burns: A clue to the alterations of magnesium and phosphate metabolism. Am J Clin Nutr 65: 1473–1481PubMedGoogle Scholar
  12. [12]
    Berger MM, Pictet A, Revelly JP et al (2000) Impact of a bicarbonated saline solution on early resuscitation after major burns. Intensive Care Med 26(9): 1382–1385PubMedCrossRefGoogle Scholar
  13. [13]
    Berger MM, Reymond MJ, Shenkin A et al (2001) Influence of selenium supplements on the post-traumatic alterations of the thyroid axis — a prospective placebo controlled trial. Intensive Care Med 27: 91–100PubMedCrossRefGoogle Scholar
  14. [14]
    Berger MM (2006) Acute copper and zinc deficiency due to exudative losses — substitution versus nutritional requirements. Burns 32: 393PubMedCrossRefGoogle Scholar
  15. [15]
    Berger MM, Eggimann P, Heyland DK et al (2006) Reduction of nosocomial pneumonia after major burns by trace element supplementation: aggregation of two randomised trials. Crit Care 10:R153:e-pub 2 NovPubMedCrossRefGoogle Scholar
  16. [16]
    Berger MM, Shenkin A (2007) Trace element requirements in critically ill burned patients. J Trace Elem Med Biol 21 [Suppl 1]: $24–48Google Scholar
  17. [17]
    Berger MM, Baines M, Raffoul W et al (2007) Trace element supplements after major burns modulate antioxidant status and clinical course by way of increased tissue trace element concentration. Am J Clin Nutr 85: 1293–1300PubMedGoogle Scholar
  18. [18]
    Berger MM, Davadant M, Marin C et al (2010) Impact of a pain protocol including hypnosis in major burns. Burns 36(5): 639–646PubMedCrossRefGoogle Scholar
  19. [19]
    Borron SW, Baud FJ, Megarbane B, Chantal B (2007) Hydroxocobalamin for severe acute cyanide poisoning by ingestion or inhalation. Am J Emerg Med 25: 551–8PubMedCrossRefGoogle Scholar
  20. [20]
    Breitenstein E, Chioléro RL, Jéquier E et al (1990) Effects of beta-blockade on energy metabolism following burns. Burns 16: 259–264PubMedCrossRefGoogle Scholar
  21. [21]
    Brusselaers N, Monstrey SJ, Vandijck DM, Blot SI (2007) Prediction of morbidity and mortality on admission to a burn unit. Plast Reconstr Surg 120: 360–1; author reply 361PubMedCrossRefGoogle Scholar
  22. [22]
    Burke JF, Wolfe RR, Mullany CJ et al (1979) Glucose requirements following burn injury. Ann Surg 190: 274–285PubMedCrossRefGoogle Scholar
  23. [23]
    Bushinsky DA, Monk RD (1998) Electrolyte quintet: Calcium. Lancet 352(9124): 306–311PubMedCrossRefGoogle Scholar
  24. [24]
    Carlson DL, Horton JW (2006) Cardiac molecular signaling after burn trauma. J Burn Care Res 27(5): 669–675PubMedCrossRefGoogle Scholar
  25. [25]
    Carter EA, Tompkins RG, Babich JW et al (1996) Decreased cerebral glucose utilization in rats during the ebb phase of thermal injury. J Trauma 40(6): 930–935PubMedCrossRefGoogle Scholar
  26. [26]
    Cheatham ML, Malbrain ML, Kirkpatrick A et al (2007) Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med 33(6): 951–962PubMedCrossRefGoogle Scholar
  27. [27]
    Chrysopoulos MT, Jeschke MG, Dziewulski P et al (1999) Acute renal dysfunction in severely burned adults. J Trauma 46: 141–144CrossRefGoogle Scholar
  28. [28]
    Chung KK, Juncos LA, Wolf SE et al (2008) Continuous Renal Replacement Therapy Improves Survival in Severely Burned Military Casualties With Acute Kidney Injury. J Trauma 64:S179–S187PubMedCrossRefGoogle Scholar
  29. [29]
    Coca SG, Bauling P, Schifftner T et al (2007) Contribution of acute kidney injury toward morbidity and mortality in burns: a contemporary analysis. Am J Kidney Dis 49: 517–523PubMedCrossRefGoogle Scholar
  30. [30]
    Cox RA, Burke AS, Soejima K et al (2003) Airway obstruction in sheep with burn and smoke inhalation injuries. Am J Respir Cell Mol Biol 29: 295–302Google Scholar
  31. [31]
    de Jonghe B, Lacherade JC, Sharshar T, Outin H (2009) Intensive care unit-acquired weakness: Risk factors and Prevention. Crit Care Med 37(10) [Suppl]: S309–S315PubMedCrossRefGoogle Scholar
  32. [32]
    Ding HQ, Zhou BJ, Liu L et al (2002) Oxidative stress and metallothionein expression in the liver of rats with severe thermal injury. Burns 28: 215–221PubMedCrossRefGoogle Scholar
  33. [33]
    Donner B, Tryba M, Kurz-Muller K et al (1996) [Anesthesia and intensive care management of severely burned children of Jehovah’s Witnesses]. Anaesthesist 45(2): 171–517PubMedCrossRefGoogle Scholar
  34. [34]
    Dubick MA, Williams C, Elgjo GI et al (2005) High-dose vitamin C infusion reduces fluid requirements in the resuscitation of burn-injured sheep. Shock 24(2): 139–144PubMedCrossRefGoogle Scholar
  35. [35]
    Erdman AR (2007) Is hydroxocobalamin safe and effective for smoke inhalation? Searching for guidance in the haze. Ann Emerg Med 49: 814–816PubMedCrossRefGoogle Scholar
  36. [36]
    Etherington L, Saffle J, Cochran A (2009) Use of transesophageal echocardiography in burns:a retrospective review. J Burn Care Res 31(1): 36–39CrossRefGoogle Scholar
  37. [37]
    Evans RA, Lawrence PJ, Thanakrishnan G et al (1986) Immobilization hypercalcaemia due to low bone formation and responding to intravenous sodium sulphate. Postgrad Med J 62(727): 395–398PubMedCrossRefGoogle Scholar
  38. [38]
    Fecher AM, O’Mara MS, Goldfarb IW et al (2004) Analysis of deep vein thrombosis in burn patients. Burns 30(6): 591–593PubMedCrossRefGoogle Scholar
  39. [39]
    Forni JG, Hilton PJ (1997) Continuous hemofiltration in the treatment of acute renal failure. N Engl J Med 336: 1303–1309PubMedCrossRefGoogle Scholar
  40. [40]
    Forster J, Querusio L, Burchard KW et al (1985) Hypercalcemia in critically ill surgical patients. Ann Surg 202: 512–518PubMedCrossRefGoogle Scholar
  41. [41]
    Gore DC, Chinkes D, Heggers J et al (2001) Association of hyperglycemia with increased mortality after severe burn injury. J Trauma 51(3): 540–544PubMedCrossRefGoogle Scholar
  42. [42]
    Herndon DN, Hart DW, Wolf SE, Chinkes DL, Wolfe RR (2001) Reversal of catabolism by beta-blockade after severe burns. N Engl J Med 345: 1223–1229PubMedCrossRefGoogle Scholar
  43. [43]
    Herndon DN, Wolf SE, Chinkes DL et al (2001) Reversal of catabolism by beta-blockade after severe burns. N Engl J Med 345: 1223–1229PubMedCrossRefGoogle Scholar
  44. [44]
    Holm C, Horbrand F, von Donnersmarck GH et al (1999) Acute renal failure in severely burned patients. Burns 25: 171–178PubMedCrossRefGoogle Scholar
  45. [45]
    Holm C, Melcer B, Hörbrand F et al (2000) Intrathoracic blood volume as an endpoint in resuscitation of the severely burned: an observational study of 24 patients. J Trauma 48: 728–734PubMedCrossRefGoogle Scholar
  46. [46]
    Holm C, Mayr M, Tegeler J et al (2004) A clinical randomized study on the effects of invasive monitoring on burn shock resuscitation. Burns 30(8): 798–807PubMedCrossRefGoogle Scholar
  47. [47]
    Horton JW, Garcia NM, White DJ et al (1995) Postburn cardiac contractile function and biochemical markers of postburn cardiac surgery. J Am Coll Surg 181: 289–298PubMedGoogle Scholar
  48. [48]
    Horton JW, White DJ, Maass DL et al (2001) Antioxidant vitamin therapy alters burn trauma-mediated cardiac NF-kappaB activation and cardiomyocyte cytokine secretion. J Trauma 50(3): 397–406PubMedCrossRefGoogle Scholar
  49. [49]
    Huang PP, Stucky FS, Dimick AR et al (1995) Hypertonic sodium resuscitation is associated with renal failure and death. Ann Surg 221: 543–557PubMedCrossRefGoogle Scholar
  50. [50]
    Inzucchi SE (2004) Management of hypercalcemia: diagnostic workup, therapeutic options for hyperpararthyroidism and their common causes. Postgrad Med J 115(5): 27–36Google Scholar
  51. [51]
    Ivy ME, Atweh NA, Palmer J et al (2000) Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma 49: 387–391PubMedCrossRefGoogle Scholar
  52. [52]
    Jeschke MG, Barrow RE, Mlcak RP et al (2005) Endogenous anabolic hormones and hypermetabolism: effect of trauma and gender differences. Ann Surg 241(5): 759–767PubMedCrossRefGoogle Scholar
  53. [53]
    Jeschke MG, Micak RP, Finnerty CC, Herndon DN (2007) Changes in liver function and size after a severe thermal injury. Shock 28: 172–177PubMedCrossRefGoogle Scholar
  54. [54]
    Jeschke MG, Finnerty CC, Suman OE et al (2007) The effect of oxandrolone on the endocrinologic, inflammatory, and hypermetabolic responses during the acute phase postburn. Ann Surg 246(3): 351–360; discussion 360-352PubMedCrossRefGoogle Scholar
  55. [55]
    Jeschke MG, Finnerty CC, Kulp GA et al (2008) Combination of recombinant human growth hormone and propranolol decreases hypermetabolism and inflammation in severely burned children. Pediatr Crit Care Med 9(2): 209–216PubMedCrossRefGoogle Scholar
  56. [56]
    Jeschke MG, Gauglitz GG, Song J, MD et al (2009) Calcium and ER Stress Mediate Hepatic Apoptosis after Burn Injury. J Cell Mol Med 13(8B):1857–1865PubMedCrossRefGoogle Scholar
  57. [57]
    Kealey GP (2009) Effects/Treatment of Toxic Gases. J Burn Care Res 30(1): 146–155PubMedCrossRefGoogle Scholar
  58. [58]
    Klein GL, Kikuchi Y, Sherrard DJ et al (1996) Burn-associated bone disease in sheep: roles of immobilization and endogenous corticosteroids. J Burn Care Rehabil 17: 518–521PubMedCrossRefGoogle Scholar
  59. [59]
    Klein GL, Wolf SE, Langman CB et al (1998) Effect of therapy with recombinant human growth hormone on insulin-like growth factor system components and serum levels of biochemical markers of bone formation in children after severe burn injury. J Clin Endocrinol Metab 83: 21–24PubMedCrossRefGoogle Scholar
  60. [60]
    Klein GL, Wimalawansa SJ, Kulkarni G et al (2005) The efficacy of acute administration of pamidronate on the conservation of bone mass following severe burn injury in children: a double-blind, randomized, controlled study. Osteoporos Int 16(6): 631–635PubMedCrossRefGoogle Scholar
  61. [61]
    Klein GL (2006) Burn-induced bone loss: importance, mechanisms, and management. J Burns Wounds 5:e5PubMedGoogle Scholar
  62. [62]
    Kohut B, Rossat J, Raffoul W et al (2009) Hypercalcaemia and acute renal failure after major burns: An under-diagnosed condition. Burns 34(3): 360–366Google Scholar
  63. [63]
    Lam NN, Tien NG, Khoa CM (2008) Early enteral feeding for burned patients: an effective method which should be encouraged in developing countries. Burns 34(2): 192–196PubMedCrossRefGoogle Scholar
  64. [64]
    Lavrentieva A, Kontakiotis T, Bitzani M et al (2008) Early coagulation disorders after severe burn injury: impact on mortality. Intensive Care Med 34(4): 700–706PubMedCrossRefGoogle Scholar
  65. [65]
    Lund T, Onarheim H, Reed RK (1992) Pathogenesis of edema formation in burn injuries. World J Surg 16: 2–9PubMedCrossRefGoogle Scholar
  66. [66]
    Marano MA, Fong Y, Moldawer LL et al (1990) Serum cachectin: tumor necrosis factor in critically ill patients with burns correlates with infection and mortality. Surg Gynecol Obstet 170: 32–38PubMedGoogle Scholar
  67. [67]
    Mégarbane B, Delahaye A, Goldgran-Toledano D, Baud FJ (2003) Antidotal treatment of cyanide poisoning. J Chin Med Assoc 66: 193–203PubMedGoogle Scholar
  68. [68]
    Morio B, Irtun O, Herndon DN et al (2002) Propranolol decreases splanchnic triacylglycerol storage in burn patients receiving a high-carbohydrate diet. Ann Surg 236(2): 218–225PubMedCrossRefGoogle Scholar
  69. [69]
    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(6): 910–928.PubMedGoogle Scholar
  70. [70]
    Mustonen KM, Vuola J (2008) Acute Renal Failure in Intensive Care Burn Patients (ARF in Burn Patients). J Burn Care Res 29: 227–237.PubMedGoogle Scholar
  71. [71]
    Namias N (2007) Advances in burn care. Curr Opin Crit Care 13(4): 405–410PubMedCrossRefGoogle Scholar
  72. [72]
    Niedermayr M, Schramm W, Kamolz L et al (2007) Antithrombin deficiency and its relationship to severe burns. Burns 33(2): 173–178PubMedCrossRefGoogle Scholar
  73. [73]
    Palmieri T, Enkhbaatar P, Bayliss R et al (2006) Continuous nebulized albuterol attenuates acute lung injury in an ovine model of combined burn and smoke inhalation. Crit Care Med 34: 1719–1724PubMedCrossRefGoogle Scholar
  74. [74]
    Pereira C, Murphy K, Herndon D (2004) Outcome measures in burn care: is mortality dead? Burns 30: 761–771PubMedCrossRefGoogle Scholar
  75. [75]
    Pham TN, Warren AJ, Phan HH et al (2005) Impact of tight glycemic control in severely burned children. J Trauma 59(5): 1148–1154PubMedCrossRefGoogle Scholar
  76. [76]
    Pierre EJ, Barrow RE, Hawkins HK et al (1998) Effects of insulin on wound healing. J Trauma 44: 342–345PubMedCrossRefGoogle Scholar
  77. [77]
    Popp M, Friedberg D, McMillan B (1980) Clinical characteristics of hypertension in burned children. Ann Surg 191: 473–478PubMedCrossRefGoogle Scholar
  78. [78]
    Price LA, Thombs B, Chen CL, Milner SM (2007) Liver disease in burn injury: evidence from a national sample of 31,338 adult patients. J Burns Wounds 7: e1PubMedGoogle Scholar
  79. [79]
    Pruitt BA Jr, Foley F D, Moncrief J A (1970) Curling’s ulcer: a clinical-pathology study of 323 cases. Ann Surg 172: 523–539PubMedCrossRefGoogle Scholar
  80. [80]
    Pruitt BA Jr (2000) Protection from excessive resuscitation: “pushing the pendulum back”. J Trauma 49: 567–568PubMedCrossRefGoogle Scholar
  81. [81]
    Przkora R, Herndon DN, Sherrard DJ et al (2007) Pamidronate preserves bone mass for at least 2 years following acute administration for pediatric burn injury. Bone 41(2): 297–302PubMedCrossRefGoogle Scholar
  82. [82]
    Rainville P, Bao QV, Chretien P (2005) Pain-related emotions modulate experimental pain perception and autonomic responses. Pain 118(3): 306–318PubMedCrossRefGoogle Scholar
  83. [83]
    Rainville P (2008) Hypnosis and the analgesic effect of suggestions. Pain 134(1–2): 1–2PubMedCrossRefGoogle Scholar
  84. [84]
    Raff T, Hartmann B, Germann G (1997) Early intragastric feeding of seriously burned and long-term ventilated patients: a review of 55 patients. Burns 23: 19–25PubMedCrossRefGoogle Scholar
  85. [85]
    Richardson P, Mustard L (2009) The management of pain in the burns unit. Burns 35(7): 921–936PubMedCrossRefGoogle Scholar
  86. [86]
    Rossaint R, Falke KJ, Lopez F, Slama K, Pison U, Zapol WM (1993) Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med 328: 399–405PubMedCrossRefGoogle Scholar
  87. [87]
    Saffle JR (2007) The phenomenon of “fluid creep” in acute burn resuscitation. J Burn Care Res 28 (May/ june):382–395PubMedCrossRefGoogle Scholar
  88. [88]
    Sam R, Vaseemuddin M, Siddique A et al (2007) Hypercalcemia in patients in the burn intensive care unit. J Burn Care Res 28: 742–746PubMedCrossRefGoogle Scholar
  89. [89]
    Shankar R, Melstrom KA Jr, Gamelli RL (2007) Inflammation and sepsis: past, present, and the future. J Burn Care Res 28(4): 566–571PubMedCrossRefGoogle Scholar
  90. [90]
    Shepherd G, Velez LI (2008) Role of hydroxocobalamin in acute cyanide poisoning. Ann Pharmacother 42: 661–669PubMedCrossRefGoogle Scholar
  91. [91]
    Sheridan RL (2009) Inhaled nitric oxide in inhalation injury. J Burn Care Res 30(1): 162–163PubMedCrossRefGoogle Scholar
  92. [92]
    Shiozaki T, Kishikawa M, Hiraide A et al (1993) Recovery from postoperative hypothermia predicts survival in extensively burned patients. Am J Surg 165: 326–330PubMedCrossRefGoogle Scholar
  93. [93]
    Song J, Finnerty CC, Herndon DN, Boehning D, Jeschke MG (2009) Severe burn-induced endoplasmic reticulum stress and hepatic damage in mice. Mol Med 15(9–10): 316–320PubMedGoogle Scholar
  94. [94]
    Sparkes BG (1997) Immunological responses to thermal injury. Burns 23: 106–113PubMedCrossRefGoogle Scholar
  95. [95]
    Stucki P, Perez MH, Cotting J, Shenkin A, Berger MM (2010) Substitution of exudative trace elements losses in burned children. Critical Care 14: 439PubMedCrossRefGoogle Scholar
  96. [96]
    Sullivan SR, Friedrich JB, Engrav LH, Round KA, Heimbach DM, Heckbert SR, Carrougher GJ, Lezotte DC, Wiechman SA, Honari S, Klein MB, Gibran NS (2004) “Opioid creep” is real and may be the cause of “fluid Creep”. Burns 30(6): 583–90PubMedCrossRefGoogle Scholar
  97. [97]
    Szyfelbein SK, Drop LJ, Martyn JAJ (1981) Persistent ionized hypocalcemia in patients during resuscitation and recovery phases of body burns. Crit Care Med 9: 454–458PubMedCrossRefGoogle Scholar
  98. [98]
    Takala J, Ruokonen E, Webster NR et al (1999) Increased mortality associated with growth hormone treatment in critically ill adults. N Engl J Med 341: 785–792PubMedCrossRefGoogle Scholar
  99. [99]
    Tanaka H, Matsuda T, Miyagantani Y et al (2000) Reduction of resuscitation fluid volumes in severely burned patients using ascorbic acid administration. Arch Surg 135: 326–331PubMedCrossRefGoogle Scholar
  100. [100]
    Tappy L, Schwarz JM, Schneiter P et al (1998) Effects of isoenergetic glucose-based or lipid-based parenteral nutrition on glucose metabolism, de novo lipogenesis, and respiratory gas exchanges in critically ill patients. Crit Care Med 26: 860–867PubMedCrossRefGoogle Scholar
  101. [101]
    Tasaki O, Mozingo DW, Dubick MA, Goodwin CW, Yantis LD, Pruitt BA Jr (2002) Effects of heparin and lisofylline on pulmonary function after smoke inhalation injury in an ovine model. Crit Care Med 30: 637–43PubMedCrossRefGoogle Scholar
  102. [102]
    Thomas S, Wolf SE, Chinkes DL, Herndon DN (2004) Recovery from the hepatic acute phase response in the severely burned and the effects of long-term growth hormone treatment. Burns 30: 675–9PubMedCrossRefGoogle Scholar
  103. [103]
    Warden GD (1996) Fluid resuscitation and early management. In: Herndon D (ed) Total burns care. Saunders, London, pp 53-60Google Scholar
  104. [104]
    Weaver LK (2009) Clinical practice. Carbon monoxide poisoning. N Engl J Med 360: 1217–1225PubMedCrossRefGoogle Scholar
  105. [105]
    Wibbenmeyer L, Sevier A, Liao J, Williams I, Light T, Latenser B, Lewis R 2nd, Kealey P, Rosenquist R (2010) The impact of opioid administration on resuscitation volumes in thermally injured patients. J Burn Care Res 31(1): 48–56PubMedCrossRefGoogle Scholar
  106. [106]
    Wolf SE, Debroy M, Herndon DN (1997) The cornerstones and directions of pediatric burn care. Pediatric Surgery International 12: 312–320PubMedCrossRefGoogle Scholar
  107. [107]
    Wolf SE, Edelman LS, Kemalyan N et al (2006) Effects of oxandrolone on outcome measures in the severely burned: a multicenter prospective randomized double-blind trial. J Burn Care Rehab 27(2): 131–139; discussion 140-141CrossRefGoogle Scholar
  108. [108]
    Zhang Q, Carter EA, Ma B et al (2008) Burn-related metabolic and signaling changes in rat brain. J Burn Care Res 29(2): 346–352PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2012

Authors and Affiliations

  • Mette M. Berger
    • 1
  • Shahriar Shahrokhi
    • 2
  • Marc G. Jeschke
    • 2
  1. 1.Adult ICU and Burn UnitUniversity Hospital (CHUV)LausanneSwitzerland
  2. 2.Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Department of Surgery, Division of Plastic SurgeryUniversity of TorontoTorontoCanada

Personalised recommendations