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Critical Care of Burn Victims Including Inhalation Injury

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Burn Care and Treatment

Abstract

There is no greater trauma than major burn injury, which can be classified according to different burn causes and different depths. More than 500,000 burn injuries occur annually in the USA per year [1]. Although most of these burn injuries are minor, approximately 40,000–60,000 burn patients require admission to a hospital or major burn center for appropriate treatment. The devastating consequences of burns have been recognized by the medical community, and significant amounts of resources and research have been dedicated, successfully improving these dismal statistics [2–4]. Specialized burn centers and advances in therapy strategies, based on improved understanding of resuscitation, protocolized and specialized critical care, enhanced wound coverage, more appropriate infection control, improved treatment of inhalation injury, and better support of the hypermetabolic response to injury, have further improved the clinical outcome of this unique patient population over the past years [4, 5]. However, severe burns remain a devastating injury affecting nearly every organ system and leading to significant morbidity and mortality [2–6]. Of all cases, nearly 4,000 people die of complications related to thermal injury [2].

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References

  1. WHO (2002) A graphical overview of the global burden of injuries. The injury chart book, vol 29. WHO, Geneva

    Google Scholar 

  2. Herndon DN (2007) Treatment of infection in burns. In: Herndon DN (ed) Total burn care, 3rd edn. Saunders Elsevier, Philadelphia

    Google Scholar 

  3. Herndon DN, Tompkins RG (2004) Support of the metabolic response to burn injury. Lancet 363(9424):1895–1902

    Article  PubMed  CAS  Google Scholar 

  4. Jeschke MG et al (2012) Handbook of burns, vol 1. Springer, Wien New York

    Book  Google Scholar 

  5. Kraft R et al (2012) Burn size and survival probability in paediatric patients in modern burn care: a prospective observational cohort study. Lancet 379(9820):1013–1021

    Article  PubMed  Google Scholar 

  6. Jeschke MG et al (2008) Pathophysiologic response to severe burn injury. Ann Surg 248(3):387–401

    PubMed  Google Scholar 

  7. Williams FN et al (2009) The leading causes of death after burn injury in a single pediatric burn center. Crit Care 13(6):R183

    Article  PubMed  Google Scholar 

  8. Barrow RE, Jeschke MG, Herndon DN (2000) Early fluid resuscitation improves outcomes in severely burned children. Resuscitation 45(2):91–96

    Article  PubMed  CAS  Google Scholar 

  9. Greenhalgh DG (2007) Burn resuscitation. J Burn Care Res 28(4):555–565

    Article  PubMed  Google Scholar 

  10. Greenhalgh DG (2010) Burn resuscitation: the results of the ISBI/ABA survey. Burns 36(2):176–182

    Article  PubMed  Google Scholar 

  11. Kraft R et al. (2012) Optimized fluid management improves outcomes of pediatric burn patients. J Surg Res 2012 June 6 Epub first

    Google Scholar 

  12. Wolf SE et al (1997) Mortality determinants in massive pediatric burns. An analysis of 103 children with >  or  =  80 % TBSA burns (> or  =  70 % full-thickness). Ann Surg 225(5):554–565; discussion 565–569

    Article  PubMed  CAS  Google Scholar 

  13. Greenhalgh DG et al (2007) American Burn Association consensus conference to define sepsis and infection in burns. J Burn Care Res 28(6):776–790

    Article  PubMed  Google Scholar 

  14. Latenser BA (2009) Critical care of the burn patient: the first 48 hours. Crit Care Med 37(10):2819–2826

    Article  PubMed  CAS  Google Scholar 

  15. Pham TN, Cancio LC, Gibran NS (2008) American Burn Association practice guidelines burn shock resuscitation. J Burn Care Res 29(1):257–266

    PubMed  Google Scholar 

  16. Klein MB et al (2007) The association between fluid administration and outcome following major burn: a multicenter study. Ann Surg 245(4):622–628

    Article  PubMed  Google Scholar 

  17. Rivers E et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377

    Article  PubMed  CAS  Google Scholar 

  18. Saffle JI (2007) The phenomenon of “fluid creep” in acute burn resuscitation. J Burn Care Res 28(3):382–395

    Article  PubMed  Google Scholar 

  19. Ivy ME et al (2000) Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma 49(3):387–391

    Article  PubMed  CAS  Google Scholar 

  20. Faraklas I et al (2011) Colloid normalizes resuscitation ratio in pediatric burns. J Burn Care Res 32(1):91–97

    Article  PubMed  Google Scholar 

  21. Palmieri TL et al (2009) Inhalation injury in children: a 10 year experience at Shriners Hospitals for Children. J Burn Care Res 30(1):206–208

    Article  PubMed  Google Scholar 

  22. Sheridan RL, Hess D (2009) Inhaled nitric oxide in inhalation injury. J Burn Care Res 30(1):162–164

    Article  PubMed  Google Scholar 

  23. Endorf FW, Gamelli RL (2007) Inhalation injury, pulmonary perturbations, and fluid resuscitation. J Burn Care Res 28(1):80–83

    Article  PubMed  Google Scholar 

  24. Erdman AR (2007) Is hydroxocobalamin safe and effective for smoke inhalation? Searching for guidance in the haze. Ann Emerg Med 49(6):814–816

    Article  PubMed  Google Scholar 

  25. Finnerty CC, Herndon DN, Jeschke MG (2007) Inhalation injury in severely burned children does not augment the systemic inflammatory response. Crit Care 11(1):R22

    Article  PubMed  Google Scholar 

  26. Barrow RE et al (2005) Mortality related to gender, age, sepsis, and ethnicity in severely burned children. Shock 23(6):485–487

    PubMed  Google Scholar 

  27. Branski LK et al (2011) Transpulmonary thermodilution for hemodynamic measurements in severely burned children. Crit Care 15(2):R118

    Article  PubMed  Google Scholar 

  28. Kuntscher MV et al (2002) Transcardiopulmonary vs pulmonary arterial thermodilution methods for hemodynamic monitoring of burned patients. J Burn Care Rehabil 23(1):21–26

    Article  PubMed  Google Scholar 

  29. de Jonge E, Bos MM (2009) Patients with cancer on the ICU: the times they are changing. Crit Care 13(2):122

    Article  PubMed  Google Scholar 

  30. Gore DC et al (2003) Influence of fever on the hypermetabolic response in burn-injured children. Arch Surg 138(2):169–174; discussion 174

    Article  PubMed  Google Scholar 

  31. Hogan BK et al (2012) Correlation of American Burn Association sepsis criteria with the presence of bacteremia in burned patients admitted to the intensive care unit. J Burn Care Res 33(3):371–378

    Article  PubMed  Google Scholar 

  32. Murray CK et al (2007) Evaluation of white blood cell count, neutrophil percentage, and elevated temperature as predictors of bloodstream infection in burn patients. Arch Surg 142(7):639–642

    Article  PubMed  Google Scholar 

  33. Mosier MJ et al (2011) Early enteral nutrition in burns: compliance with guidelines and associated outcomes in a multicenter study. J Burn Care Res 32(1):104–109

    Article  PubMed  Google Scholar 

  34. Williams FN et al (2009) Modulation of the hypermetabolic response to trauma: temperature, nutrition, and drugs. J Am Coll Surg 208(4):489–502

    Article  PubMed  Google Scholar 

  35. Pereira C, Murphy K, Herndon D (2004) Outcome measures in burn care. Is mortality dead? Burns 30(8):761–771

    Article  PubMed  Google Scholar 

  36. Pereira CT et al (2006) Age-dependent differences in survival after severe burns: a unicentric review of 1,674 patients and 179 autopsies over 15 years. J Am Coll Surg 202(3):536–548

    Article  PubMed  Google Scholar 

  37. Jeschke MG et al (2011) Long-term persistance of the pathophysiologic response to severe burn injury. PLoS One 6(7):e21245

    Article  PubMed  CAS  Google Scholar 

  38. Jeschke MG (2009) The hepatic response to thermal injury: is the liver important for postburn outcomes? Mol Med 15(9–10):337–351

    PubMed  CAS  Google Scholar 

  39. Price LA et al (2007) Liver disease in burn injury: evidence from a national sample of 31,338 adult patients. J Burns Wounds 7:e1

    PubMed  Google Scholar 

  40. Jeschke MG et al (2011) Insulin protects against hepatic damage postburn. Mol Med 17(5–6):516–522

    PubMed  CAS  Google Scholar 

  41. Gauglitz GG et al (2010) Post-burn hepatic insulin resistance is associated with endoplasmic reticulum (ER) stress. Shock 33(3):299–305

    Article  PubMed  CAS  Google Scholar 

  42. Song J et al (2009) Severe burn-induced endoplasmic reticulum stress and hepatic damage in mice. Mol Med 15(9–10):316–320

    PubMed  Google Scholar 

  43. Jeschke MG et al (2009) Calcium and Er stress mediate hepatic apoptosis after burn injury. J Cell Mol Med 13:1857–1865

    Article  PubMed  Google Scholar 

  44. Jeschke MG, Mlcak RP, Herndon DN (2007) Morphologic changes of the liver after a severe thermal injury. Shock 28(2):172–177

    Google Scholar 

  45. Jeschke MG et al (2007) Changes in liver function and size after a severe thermal injury. Shock 28(2):172–177

    Article  PubMed  Google Scholar 

  46. Ivy ME et al (1999) Abdominal compartment syndrome in patients with burns. J Burn Care Rehabil 20(5):351–353

    Article  PubMed  CAS  Google Scholar 

  47. Baxter CR (1987) Metabolism and nutrition in burned patients. Compr Ther 13(1):36–42

    PubMed  CAS  Google Scholar 

  48. Medlin S (2012) Nutrition for wound healing. Br J Nurs 21(12):S11–S12, S14–15

    PubMed  Google Scholar 

  49. Kremer T et al (2010) High-dose vitamin C treatment reduces capillary leakage after burn plasma transfer in rats. J Burn Care Res 31(3):470–479

    Article  PubMed  Google Scholar 

  50. Tanaka H et al (2000) Reduction of resuscitation fluid volumes in severely burned patients using ascorbic acid administration: a randomized, prospective study. Arch Surg 135(3):326–331

    Article  PubMed  CAS  Google Scholar 

  51. Chrysopoulo MT et al (1999) Acute renal dysfunction in severely burned adults. J Trauma 46(1):141–144

    Article  PubMed  CAS  Google Scholar 

  52. Jeschke MG et al (1998) Mortality in burned children with acute renal failure. Arch Surg 133(7):752–756

    Article  PubMed  CAS  Google Scholar 

  53. Kallinen O et al (2012) Multiple organ failure as a cause of death in patients with severe burns. J Burn Care Res 33(2):206–211

    Article  PubMed  Google Scholar 

  54. Holm C et al (1999) Acute renal failure in severely burned patients. Burns 25(2):171–178

    Article  PubMed  CAS  Google Scholar 

  55. Przkora R et al (2006) Body composition changes with time in pediatric burn patients. J Trauma 60(5):968–971; discussion 971

    Article  PubMed  Google Scholar 

  56. Przkora R, Herndon DN, Suman OE (2007) The effects of oxandrolone and exercise on muscle mass and function in children with severe burns. Pediatrics 119(1):e109–e116

    Article  PubMed  Google Scholar 

  57. Jeschke MG et al (2005) Endogenous anabolic hormones and hypermetabolism: effect of trauma and gender differences. Ann Surg 241(5):759–767; discussion 767–768

    Article  PubMed  Google Scholar 

  58. Jeschke MG et al (2008) Gender differences in pediatric burn patients: does it make a difference? Ann Surg 248(1):126–136

    Article  PubMed  Google Scholar 

  59. Przkora R et al (2006) Beneficial effects of extended growth hormone treatment after hospital discharge in pediatric burn patients. Ann Surg 243(6):796–801; discussion 801–803

    Article  PubMed  Google Scholar 

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Correspondence to Marc G. Jeschke MD, PhD, FACS, FCCM, FRCS(C) .

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Jeschke, M.G. (2013). Critical Care of Burn Victims Including Inhalation Injury. In: Jeschke, M., Kamolz, LP., Shahrokhi, S. (eds) Burn Care and Treatment. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1133-8_6

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  • DOI: https://doi.org/10.1007/978-3-7091-1133-8_6

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  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-1132-1

  • Online ISBN: 978-3-7091-1133-8

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