Prevention and treatment of gastrointestinal dysfunction following severe burns: A summary of recent 30-year clinical experience

Abstract

(P < 0.05 or P < 0.01), and the occurrence of stress ulcer was also significantly lower than that in stage 2 patients (P < 0.05). CONCLUSION: Comprehensive fluid resuscitation, early excision of necrotic tissue, staged food ingestion, and administration of specific nutrients are essential strategies for preventing gastrointestinal complications and lowering mortality in severely burned patients. INTRODUCTIONGastrointestinal dysfunction is a common complication of severe burns. Injury to GI function, especially to GI barrier function, is an important initiator as well as a stimulator for occurrence of systemic inflammatory response syndrome (SIRS), sepsis and multiple organ dysfunction syndrome (MODS) following severe burns [1] . With the deeper understanding of GI function and changes in the stereotype of clinical treatment in recent 30 years, a series of new therapies including fluid resuscitation, early escharectomy, continuous renal replacement therapy, and use of glutamine and growth factor has been adopted in the treatment of severe burns [2,3] . Although animal experiments have shown that these new therapies do play a positive role in the prevention and treatment of GI dysfunction following severe burns, there has been a lack of convincing clinical Abstract AIM: To sum up the recent 30-year experience in the prevention and treatment of gastrointestinal dysfunction in severe burn patients, and propose practicable guidelines for the prevention and treatment of gastrointestinal (GI) dysfunction. METHODS: From 1980 to 2007, a total of 219 patients with large area and extraordinarily large area burns (LAB) were admitted, who were classified into three stages according the therapeutic protocols used at the time: Stage 1 from 1980 to 1989, stage 2 from 1990 to 1995, and stage 3 from 1996 to 2007. The occurrence and mortality of GI dysfunction in patients of the three stages were calculated and the main causes were analyzed. RESULTS: The occurrence of stress ulcer in patients with LAB was 8.6% in stage 1, which was significantly lower than that in stage 1 (P < 0.05). No massive hemorrhage from severe stress ulcer and enterogenic infections occurred in stages 2 and 3. The occurrence of abdominal distension and stress ulcer and the mortality in stage 3 patients with extraordinarily LAB was 7.1%, 21.4% and 28.5%, respectively, which were significantly lower than those in stage 1 patients

Early Enteral Nutrition in Burns: Compliance With Guidelines and Associated Outcomes in a Multicenter Study

“…13 A recent review of patients treated over 30 years indicates that modern resuscitation combined with early EN has nearly eliminated the incidence of significant stress ulceration. 13 However, it has been difficult to show impact on nutritional, metabolic, or biochemical markers and clinical outcomes, such as LOS, infection rates, and mortality. 14 …”

Analgesia and sedation for children undergoing burn wound care

“…GI dysfunction and injury can initiate or stimulate occurrence of systemic inflammatory response syndrome, sepsis and multiple organ dysfunction syndrome following severe burns [34].…”

Pediatric burn injuries

“…Gastrointestinal system dysfunction with bacterial translocation across the gut is a common complication of major burn injury and an independent cause of septic shock in the post-burn patient. [ 16 ] Bleeding from acute ulceration of the gastric mucosa may contribute to hypotension, anemia, and possible perforation, peritonitis, and septic shock. [ 17 ] Finally, the acute decrease in gastric emptying may put the burn patient at risk for aspiration during periods of sedation, airway instrumentation, or changes in mental status.…”