Anaesthesia and intensive care for major burns

Якісна Клінічна Практика Стартової Інтенсивної Терапії При Бойовій І Цивільній Політравмі (Огляд Літератури)

“…Стандартно можно начинать с 2 мл/кг/ч и увеличивать через каждые 3 ч до инди-видуально необходимой скорости для каждого паци-ента. Для мониторинга эффективности реанимации при ожогах используют уровень гематокрита, кото-рый должен быть ниже 40 % в течение первых 6 ч, и диурез, который должен поддерживаться на уровне около 1 мл/кг/час [68,69].…”

A 20 year old man with a high pressure steam burn

“…4 Inhalational injury can be described as damage to the respiratory tract by inhalation of heated or noxious substances. It occurs in 15-30% of major burn injuries and increases mortality substantially.…”

“…2 4 Dyspnoea, coughing, and wheezing may be evidence of inhalational injury to the lower airways. 4 If any of these features are present then an assessment by a healthcare professional with advanced airway skills-such as a senior anaesthetist-is warranted, because tracheal intubation should be considered. A delay in airway assessment or intervention could allow airway and pulmonary oedema to develop.…”

“…Escharotomies may be needed if burnt tissue impairs ventilation. 4 Analysis of arterial blood gases may identify a high degree of carboxyhaemoglobinaemia, which might require treatment with 100% oxygen or hyperbaric oxygen therapy in special circumstances. 7 However, this may impede effective burn management.…”

Anesthetic management with extracorporeal membrane oxygenation in a patient with acute airway obstruction after inhalation burn injury -A case report-

“…Inhalation burn injury has a risk of causing various airway complications such as upper airway obstruction due to secondary edema, reactive bronchospasm from aerosolized irritants, and lower airway obstruction by sloughed endobronchial debris. Lower airway thermal injury caused by the aspiration of products of incomplete combustion can cause sloughing of the airway epithelium, which can lead to the development of complete upper airway obstruction [2].…”