Contemporary Burn Survival

Abstract

The reduction in mortality over time may be attributed to successful changes in standard of care protocols in the burn center that improved the outlook for burned individuals, including protocols for management of inhalation injury, nutrition, resuscitation, and early excision and grafting.

Erstversorgung und Intensivmedizin Schwerbrandverletzter

“…Die Mortalität einer schweren Verbrennungsverletzung ist in Ländern wie Deutschland, Kanada oder den USA in den letzten Jahrzehnten kontinuierlich und stark rückläufig: Bedeutete in den 1980er-Jahren für einen Erwachsenen noch eine Verbrennung von 40 % der Körperoberfläche (VKOF) eine Mortalitätswahrscheinlichkeit von 50 %, so liegt diese VKOF heute für eine vergleichbare Sterbe-wahrscheinlichkeit bei ca. 80 % [4]. Die Gründe für diese günstige Entwicklung sind vielfältig: Neben großen Fortschritten in der Intensivmedizin allgemein, die durch verbesserte technische und medikamentöse Therapieoptionen und eine immer weiter zunehmende Standardisierung effektiver Behandlungskonzepte erzielt wurden, haben sich verbrennungsspezifische chirurgische und nicht chirurgische Konzepte durchgesetzt, die im Folgenden näher beleuchtet werden.…”

Epidemiology of injuries from fire, heat and hot substances: global, regional and national morbidity and mortality estimates from the Global Burden of Disease 2017 study

“…The severity spectrum of such injuries may necessitate complex treatment by burn surgeons and intensive care services that are not reliably available in all areas of the world. When it comes to injuries such as burns, medical and surgical care advents such as split-thickness skin grafting in select anatomical locations, fluid and electrolyte repletion, and infection control have emerged as critical elements of care for victims of these injuries, in some scenarios mitigating risk of death and long-term disability 1. Comprehensive medical infrastructure for treating burn injuries is therefore a critical component of a healthcare system.…”

“…Given the care requirements that severe injuries can demand, a detailed epidemiological assessment of the morbidity and mortality that can result from fire, heat and hot substances is important. Moreover, these injuries may become increasingly topical as there is increasing emphasis on ensuring that all areas of the world have access to standard-of-care interventions that have led to improved patient outcomes across various domains of illness and injury in resource-rich settings 1…”

Energy Expenditure and Protein Requirements Following Burn Injury

“…Clinicians have long been battling hypermetabolism, loss of lean body mass, and the resultant morbidity and mortality that follows severe burn injury. As early mortality following these injuries has decreased, a growing number of patients return in follow‐up with healing wounds but persistent fatigue, inability to regain lost weight, and substantial functional impairment . The exaggerated stress response to injury manifests acutely in a variety of ways, including tachycardia, insulin resistance, elevated body temperature, loss of lean body mass, fatigue, and immunosuppression.…”

“…As early mortality following these injuries has decreased, a growing number of patients return in follow-up with healing wounds but persistent fatigue, inability to regain lost weight, and substantial functional impairment. 1,2 The exaggerated stress response to injury manifests acutely in a variety of ways, including tachycardia, insulin resistance, elevated body temperature, loss of lean body mass, fatigue, and immunosuppression. Coupled with elevated resting energy expenditure (REE) and increased catabolism, these clinical conditions define the persistent hypermetabolic state in which acute injuries transition to a state of chronic illness.…”