Current Treatment of Severely Burned Patients

Abstract

ObjectiveThe authors provide an update on a multidisciplinary approach to the treatment of severely burned patients. A review of studies and clinical trials from the past to the present include fluid resuscitation, sepsis, immune function, hypermetabolism, early excision, wound healing, scar formation, and inhalation injury. Summary Background DataAdvances in treating initial burn shock, infection control, early wound closure, and modulation of the hypermetabolic response have decreased morbidity and mortality in the last two decades. Specialized burn care centers, using a multidisciplinary approach, not only successfully treat large burns and their complications, but provide the necessary rehabilitation and psychological support required for readjustment back into society. ConclusionsThermal injury results in a number of physiologic alterations that can be minimized by adequate fluid resuscitation to maintain tissue perfusion, early excision of burn wounds, and rapid wound coverage. These measures, in combination with antibiotic coverage and nutritional support in the form of early enteral tube feedings, will decrease the hypermetabolic response and the incidence of sepsis that can lead to hemodynamic instability and organ failure. Ongoing clinical trials using anabolic agents (e.g., recombinant human growth hormone) and pharmacologic agents that modulate inflammatory and endocrine mediators (e.g., ibuprofen and propranolol) show promise in the treatment of severe burn injuries.Major burns are relatively common injuries that require multidisciplinary treatment for patient survival and recovery. More than 1 million burn injuries occur annually in the United States. Although most of these burn injuries are minor, 60,000 to 80,000 people require admission to a hospital or to a major burn center for treatment, and 5000 of these patients die each year. In recent years, advances in burn treatment have reduced mortality rates and have improved the quality of life for burn survivors. Improvements have been made in treating initial burn shock, providing appropriate resuscitation, controlling infections, and performing life-saving and scar-reducing surgical interventions. Team efforts by surgeons, nurses, scientists, and a vast array oftherapists are making productive and social lives possible for many burn victims.Thermal injury is associated with anatomic, physiologic, endocrinologic, and immunologic alterations, which require specialized care. Cutaneous injury results

Benefit–cost analysis of moist exposed burn ointment

“…The effect of MEBO, however, cannot be equated to that of other topical agents. It has a different mechanism of action regarding eschar separation, moreover, it is peculiar in providing the necessary moist environment in conformity with the long-held and recently confirmed belief that wounds, including burn wounds, heal best in a moist environment [5]. Whether treatment of second degree burns with MEBO application alone may reduce the need for early surgical excision and skin grafting without compromising the final outcome still needs to be demonstrated.…”

“…Traditional burn wound management involved applying topical antibiotics in dressings until the eschar separated. Separation occurred by liquefaction of necrotic burn tissue by proteolytic enzymes released from proliferating pathogens within the wound [5]. More than two decades ago, Janzekovic demonstrated that early removal of the burn tissue by tangential excision reduced pain, number of operative procedures and length of hospital stay.…”

Burn Wound Infections

“…Inhalation injury should be suspected if the patient was burned in an enclosed space, has facial burns, and/or develops progressive hoarseness or stridor or a cough productive of carbonaceous sputum. The clinical effects of thermal inhalation injury typically become manifest within a few hours after injury, whereas chemical injury of the lower respiratory tract progresses more slowly (e.g., 1 to 2 days) (101,322). Stridor that develops immediately after heat injury associated with an increased respiratory rate, worsening hypoxemia, and trouble expectorating secretions are signs of worsening edema of the upper airway (e.g., glottis), and immediate airway intubation is required to maintain patency (15,95,275).…”

Lung involvement in accident victims: report of three cases

“…Most patients with inhalation injury have a normal chest radiograph at presentation and presence of pulmonary opacities on initial chest films has been implicated as a marker of severe injury and a poor prognosis. 10,13,14 Computed tomography of the chest may be helpful as an early predictor of smoke inhalation severity based on airway wall thickness. 15,16 Chest computed tomography (CT) scans may show groundglass opacities in a peribronchial distribution and/or patchy peribronchial consolidations.…”