Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2009

Open Access 01-12-2009 | Commentary

Management of burn injuries – recent developments in resuscitation, infection control and outcomes research

Author: David J Dries

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2009

Login to get access

Abstract

Introduction

Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve remote organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage soft tissue problems outside thermal injury including soft tissue infection and Toxic Epidermal Necrolysis.

Methods

A selected review of recent reports published by the American Burn Association is provided.

Results

The burn-injured patient is easily and frequently over resuscitated with complications including delayed wound healing and respiratory compromise. A feedback protocol is designed to limit the occurrence of excessive resuscitation has been proposed but no new "gold standard" for resuscitation has replaced the Parkland formula. Significant additional work has been included in recent guidelines identifying specific infectious complications and criteria for these diagnoses in the burn-injured patient. While new medical therapies have been proposed for patients sustaining inhalation injury, a new standard of medical therapy has not emerged. Renal failure as a contributor to adverse outcome in burns has been reinforced by recent data generated in Scandinavia. Of special problems addressed in burn centers, soft tissue infections and Toxic Epidermal Necrolysis have been reviewed but new treatment strategies have not been identified. The value of burn centers in management of burns and other soft tissue problems is supported in several recent reports.

Conclusion

Recent reports emphasize the dangers of over resuscitation in the setting of burn injury. No new medical therapy for inhalation injury exists but new standards for description of burn-related infections have been presented. The value of the burn center in care of soft tissue problems including Toxic Epidermal Necrolysis and soft tissue infections is supported in recent papers.
Appendix
Available only for authorised users
Literature
1.
Davis KA, Gamelli RL: Burns. Current Therapy of Trauma and Surgical Critical Care. Edited by: Asensio JA, Trunkey DD. 2008, Mosby Elsevier, Philadelphia, 569-578.CrossRef
2.
3.
Friedrich JB, Sullivan SR, Engrav LH: Is supra-Baxter resuscitation in burn patients a new phenomenon?. Burns. 2004, 30: 464-466. 10.1016/j.burns.2004.01.021.CrossRefPubMed
4.
Gibran NS, Committee on Organization and Delivery of Burn Care, American Burn Association: Practice guidelines for burn care, 2006. J Burn Care Res. 2006, 27: 437-438.CrossRefPubMed
5.
Baxter CR: Fluid volume and electrolyte changes of the early postburn period. Clin Plast Surg. 1974, 1: 693-703.PubMed
6.
Uchino S, Kellum JA, Bellomo R: Acute renal failure in critically ill patients. A multinational, multicenter study. JAMA. 2005, 294: 813-818. 10.1001/jama.294.7.813.CrossRefPubMed
7.
Barillo DJ, McManus AT, Cancio LC: Burn center management of necrotizing fasciitis. J Burn Care Rehabil. 2003, 24: 127-132. 10.1097/01.BCR.0000066790.57127.61.CrossRefPubMed
8.
Murphy JT, Purdue GF, Hunt JL: Toxic epidermal necrolysis. J Burn Care Rehabil. 1997, 18: 417-420. 10.1097/00004630-199709000-00008.CrossRefPubMed
9.
Halebian PH, Corder VJ, Madden MR: Improved burn center survival of patients with toxic epidermal necrolysis managed without corticosteroids. Ann Surg. 1986, 204: 503-512. 10.1097/00000658-198611000-00001.PubMedCentralCrossRefPubMed
10.
Brigham PA, Dimick AR: The evolution of burn care facilities in the United States. J Burn Care Res. 2008, 29: 248-256.PubMed
11.
Fontaine KR, Redden DT, Wang C: Years of life lost due to obesity. JAMA. 2003, 289: 187-193. 10.1001/jama.289.2.187.CrossRefPubMed
12.
Pham TN, Cancio LC, Gibran NS, American Burn Association: American Burn Association practice guidelines burn shock resuscitation. J Burn Care Res. 2008, 29: 257-266.CrossRefPubMed
13.
Blumetti J, Hunt JL, Arnoldo BD: The Parkland formula under fire: Is the criticism justified?. J Burn Care Res. 2008, 29: 180-186.CrossRefPubMed
14.
Saffle JI: The phenomenon of "fluid creep" in acute burn resuscitation. J Burn Care Res. 2007, 28: 382-395.CrossRefPubMed
15.
Ivy ME, Atweh NA, Palmer J: Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma. 2000, 49: 387-391. 10.1097/00005373-200009000-00001.CrossRefPubMed
16.
Jeng JC, Jaskille AD, Lunsford PM: Improved markers for burn wound perfusion in the severely burned patient: The role for tissue and gastric PCO2. J Burn Care Res. 2008, 29: 49-55.PubMed
17.
Batchinsky AI, Wolf SE, Molter N: Assessment of cardiovascular regulation after burns by nonlinear analysis of the electrocardiogram. J Burn Care Res. 2008, 29: 56-63.PubMed
18.
Norris PR, Morris JA, Ozdas A: Heart rate variability predicts trauma patient outcome as early as 12 h: Implications for military and civilian triage. J Surg Res. 2005, 129: 122-128. 10.1016/j.jss.2005.04.024.CrossRefPubMed
19.
Greenhalgh DG, Saffle JR, Holmes JH: American Burn Association consensus conference to define sepsis and infection in burns. J Burn Care Res. 2007, 28: 776-790.CrossRefPubMed
20.
Bone RC, Balk RA, Cerra FB: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992, 101: 1644-1655. 10.1378/chest.101.6.1644.CrossRefPubMed
21.
Levy MM, Fink MP, Marshall JC: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003, 31: 1250-1256. 10.1097/01.CCM.0000050454.01978.3B.CrossRefPubMed
22.
Calandra T, Cohen J, International Sepsis Forum Definition of Infection in the ICU Consensus Conference: The International Sepsis Forum Consensus Conference on definitions of infection in the intensive care unit. Crit Care Med. 2005, 33: 1538-1548. 10.1097/01.CCM.0000168253.91200.83.CrossRefPubMed
23.
Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis: International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005, 6: 2-8. 10.1097/01.PCC.0000149131.72248.E6.CrossRefPubMed
24.
Marshall JC: SIRS and MODS: What is their relevance to the science and practice of intensive care?. Shock. 2000, 14: 586-589. 10.1097/00024382-200014060-00002.CrossRefPubMed
25.
Dellinger RP, Levy MM, Carlet JM: Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008, 36: 296-327. 10.1097/01.CCM.0000298158.12101.41.CrossRefPubMed
26.
Rello J, Paiva JA, Baraibar J: International Conference for the Development of Consensus on the Diagnosis and Treatment of Ventilator-Associated Pneumonia. Chest. 2001, 120: 955-970. 10.1378/chest.120.3.955.CrossRefPubMed
27.
Hubmayr RD, Burchardi H, Elliot M: Statement of the 4th International Consensus Conference in Critical Care on ICU-Acquired Pneumonia-Chicago, Illinois, May 2002. Intensive Care Med. 2002, 28: 1521-1536. 10.1007/s00134-002-1514-0.CrossRefPubMed
28.
McGee DC, Gould MK: Preventing complications of central venous catheterization. N Engl J Med. 2003, 348: 1123-1133. 10.1056/NEJMra011883.CrossRefPubMed
29.
Calandra T, Cohen J, International Sepsis Forum Definition of Infection in the ICU Consensus Conference: The International Sepsis Forum Consensus Conference on definitions of infection in the intensive care unit. Crit Care Med. 2005, 33: 1538-1548. 10.1097/01.CCM.0000168253.91200.83.CrossRefPubMed
30.
Peck MD, Weber J, McManus A: Surveillance of burn wound infections: A proposal for definitions. J Burn Care Rehabil. 1998, 19: 386-389. 10.1097/00004630-199809000-00005.CrossRefPubMed
31.
32.
Pruitt BA, McManus AT, Kim SH: Burn wound infections: Current status. World J Surg. 1998, 22: 135-145. 10.1007/s002689900361.CrossRefPubMed
33.
Carpenter AM, Hollett LP, Jeng JC: How long a shadow does epidemic obesity cast in the burn unit? A dietitian's analysis of the strengths and weaknesses of the available data in the National Burn Repository. J Burn Care Res. 2008, 29: 97-101.PubMed
34.
35.
36.
Bochicchio GV, Joshi M, Bochicchio K: Impact of obesity in the critically ill trauma patient. A prospective study. J Am Coll Surg. 2006, 203: 533-538. 10.1016/j.jamcollsurg.2006.07.001.CrossRefPubMed
37.
Ciesla DJ, Moore EE, Johnson JL: Obesity increases risk of organ failure after severe trauma. J Am Coll Surg. 2006, 203: 539-545. 10.1016/j.jamcollsurg.2006.06.029.CrossRefPubMed
38.
Farrell RT, Gamelli RL, Aleem RF: The relationship of body mass index and functional outcomes in patients with acute burns. J Burn Care Res. 2008, 29: 102-108.PubMed
39.
van Baar ME, Essink-Bot ML, Oen IM: Functional outcomes after burns: A review. Burns. 2006, 32: 1-9. 10.1016/j.burns.2005.08.007.CrossRefPubMed
40.
Sliwa JA, Heinemann A, Semik P: Inpatient rehabilitation following burn injury: Patient demographics and functional outcomes. Arch Phys Med Rehabil. 2005, 86: 1920-1923. 10.1016/j.apmr.2005.04.024.CrossRefPubMed
41.
Farrell RT, Gamelli RL, Sinacore J: Analysis of functional outcomes in patients discharged from an acute burn center. J Burn Care Res. 2006, 27 (2): 189-194.CrossRefPubMed
42.
Bernard GR, Artigas A, Brigham KL: The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994, 149: 818-824.CrossRefPubMed
43.
Mayes T, Gottschlich MM, Kagan RJ: An evaluation of the safety and efficacy of an anti-inflammatory, pulmonary enteral formula in the treatment of pediatric burn patients with respiratory failure. J Burn Care Res. 2008, 29: 82-88.PubMed
44.
Pacht ER, DeMichele SJ, Nelson JL: Enteral nutrition with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants reduces alveolar inflammatory mediators and protein influx in patients with acute respiratory distress syndrome. Crit Care Med. 2003, 31: 491-500. 10.1097/01.CCM.0000049952.96496.3E.CrossRefPubMed
45.
Covelli HD, Black JW, Olsen MS: Respiratory failure precipitated by high carbohydrate loads. Ann Intern Med. 1981, 95: 579-581.CrossRefPubMed
46.
Gadek JE, DeMichele SJ, Karlstad MD: Effect of enteral feeding with eicosapentaenoic acid, gamma linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group. Crit Care Med. 1999, 27: 1409-1420. 10.1097/00003246-199908000-00001.CrossRefPubMed
47.
Singer P, Theilla M, Fisher H: Benefit of an enteral diet enriched with eicosapentaenoic acid and gamma-linolenic acid in ventilated patients with acute lung injury. Crit Care Med. 2006, 34: 1033-1038. 10.1097/01.CCM.0000206111.23629.0A.CrossRefPubMed
48.
Pontes-Arruda A, Aragão AM, Albuquerque JD: Effects of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and shock. Crit Care Med. 2006, 34: 2325-2333. 10.1097/01.CCM.0000234033.65657.B6.CrossRefPubMed
49.
Alexander JW, Saito H, Trocki O: The importance of lipid type in the diet after burn injury. Ann Surg. 1986, 204: 1-8. 10.1097/00000658-198607000-00001.PubMedCentralCrossRefPubMed
50.
Bistrian BR, McCowen KC: Nutritional and metabolic support in the adult intensive care unit: Key controversies. Crit Care Med. 2006, 34: 1525-1531. 10.1097/01.CCM.0000216704.54446.FD.CrossRefPubMed
51.
Holt J, Saffle JR, Morris SE: Use of inhaled heparin/N-acetylcystine in inhalation injury: Does it help?. J Burn Care Res. 2008, 29: 192-195.PubMed
52.
Desai MH, Mlcak R, Richardson J: Reduction in mortality in pediatric patients with inhalation injury with aerosolized heparin/acetylcystine therapy. J Burn Care Rehabil. 1998, 19: 210-212. 10.1097/00004630-199805000-00004.CrossRefPubMed
53.
Linares HA, Herndon DN, Traber DL: Sequence of morphologic events in experimental smoke inhalation. J Burn Care Rehabil. 1989, 10: 27-37. 10.1097/00004630-198901000-00005.CrossRefPubMed
54.
Cox CS, Zwischenberger JB, Traber DL: Heparin improves oxygenation and minimizes barotrauma after severe smoke inhalation in an ovine model. Surg Gynecol Obstet. 1993, 176: 339-349.PubMed
55.
Brown M, Desai M, Traber LD: Dimethylsulfoxide with heparin in the treatment of smoke inhalation injury. J Burn Care Rehabil. 1988, 9: 22-25. 10.1097/00004630-198801000-00007.CrossRefPubMed
56.
Baux S: Contribution a l'Etude du traitement local des brulures thermigues etendues. 1961, Paris: These
57.
Jeng JC: Patrimonie de Docteur Baux – Baux Scores >> 100 gleaned from 170,791 admissions: A glimmer from the National Burn repository. J Burn Care Res. 2007, 28: 380-381.CrossRefPubMed
58.
Miller SF, Bessey PQ, Schurr MJ: National Burn Repository 2005: A ten-year review. J Burn Care Res. 2006, 27: 411-436.CrossRefPubMed
59.
Ryan CM, Schoenfeld DA, Thorpe WP: Objective estimates of the probability of death from burn injuries. N Engl J Med. 1998, 338: 362-366. 10.1056/NEJM199802053380604.CrossRefPubMed
60.
Gomez M, Wong DT, Stewart TE: The FLAMES score accurately predicts mortality risk in burn patients. J Trauma. 2008, 65: 636-645. 10.1097/TA.0b013e3181840c6d.CrossRefPubMed
61.
Gomez M, Cartotto R, Knighton J: Improved survival following thermal injury in adult patients treated at a regional burn center. J Burn Care Res. 2008, 29: 130-137.PubMed
62.
Mustonen KM, Vuola J: Acute renal failure in intensive care burn patients (ARF in burn patients). J Burn Care Res. 2008, 29: 227-237.PubMed
63.
Morgera S, Schneider M, Neumayer HH: Long-term outcomes after acute kidney injury. Crit Care Med. 2008, 36 (Suppl): S193-S197. 10.1097/CCM.0b013e318168cae2.CrossRefPubMed
64.
Kellum JA: Acute kidney injury. Crit Care Med. 2008, 36 (Suppl): S141-S145. 10.1097/CCM.0b013e318168c4a4.CrossRefPubMed
65.
Hoste EA, Schurgers M: Epidemiology of acute kidney injury: How big is the problem?. Crit Care Med. 2008, 36 (Suppl): S146-S151. 10.1097/CCM.0b013e318168c590.CrossRefPubMed
66.
Sharp LS, Rozycki GS, Feliciano DV: Rhabdomyolysis and secondary renal failure in critically ill surgical patients. Am J Surg. 2004, 188: 801-806. 10.1016/j.amjsurg.2004.08.050.CrossRefPubMed
67.
Lyell A: Toxic epidermal necrolysis: An eruption resembling scalding of the skin. Br J Dermatol. 1956, 68: 355-361. 10.1111/j.1365-2133.1956.tb12766.x.CrossRefPubMed
68.
Abood GJ, Nickoloff BJ, Gamelli RL: Treatment strategies in toxic epidermal necrolysis syndrome: Where are we at?. J Burn Care Res. 2008, 29: 269-276.PubMed
69.
Roujeau JC: The spectrum of Stevens-Johnson syndrome and toxic epidermal necrolysis: A clinical classification. J Invest Dermatol. 1994, 102: 28S-30S. 10.1111/1523-1747.ep12388434.CrossRefPubMed
70.
Cartotto R, Mayich M, Nickerson D: SCORTEN accurately predicts mortality among toxic epidermal necrolysis patients treated in a burn center. J Burn Care Res. 2008, 29: 141-146.PubMed
71.
Bastuji-Garin S, Fouchard N, Bertocchi M: SCORTEN: A severity of illness score for toxic epidermal necrolysis. J Invest Dermatol. 2000, 115: 149-153. 10.1046/j.1523-1747.2000.00061.x.CrossRefPubMed
72.
Guégan S, Bastuji-Garin S, Poszepczynska-Guigné E: Performance of the SCORTEN during the first five days of hospitalization to predict the prognosis of epidermal necrolysis. J Invest Dermatol. 2006, 126: 272-276. 10.1038/sj.jid.5700068.CrossRefPubMed
73.
Kelemen JJ, Cioffi WG, McManus WF: Burn center care for patients with toxic epidermal necrolysis. J Am Coll Surg. 1995, 180: 273-278.PubMed
74.
Saffle JR, Morris SE, Edelman L: Fournier's gangrene: Management at a regional burn center. J Burn Care Res. 2008, 29: 196-203.PubMed
75.
Barillo DJ, McManus AT, Cancio LC: Burn center management of necrotizing fasciitis. J Burn Care Rehabil. 2003, 24: 127-132. 10.1097/01.BCR.0000066790.57127.61.CrossRefPubMed
76.
Faucher LD, Morris SE, Edelman LS: Burn center management of necrotizing soft-tissue surgical infections in unburned patients. Am J Surg. 2001, 182: 563-569. 10.1016/S0002-9610(01)00785-1.CrossRefPubMed
77.
Endorf FW, Supple KG, Gamelli RL: The evolving characteristics and care of necrotizing soft-tissue infections. Burns. 2005, 31: 269-273. 10.1016/j.burns.2004.11.008.CrossRefPubMed
78.
Ferreira PC, Reis JC, Amarante JM: Fournier's gangrene: A review of 43 reconstructive cases. Plast Reconstr Surg. 2007, 119: 175-184. 10.1097/01.prs.0000244925.80290.57.CrossRefPubMed
79.
Wang C, Schwaitzberg S, Berliner E: Hyperbaric oxygen for treating wounds: A systematic review of the literature. Arch Surg. 2003, 138: 272-280. 10.1001/archsurg.138.3.272.CrossRefPubMed
80.
Palmieri TL, London JA, O'Mara MS: Analysis of admissions and outcomes in verified and nonverified burn centers. J Burn Care Res. 2008, 29: 208-212.PubMed
81.
Ehrlich PF, Rockwell S, Kincaid S: American College of Surgeons, Committee on Trauma Verification Review: Does it really make a difference?. J Trauma. 2002, 53: 811-816. 10.1097/00005373-200211000-00001.CrossRefPubMed
82.
Sheridan R, Weber J, Prelack K: Early burn center transfer shortens the length of hospitalization and reduces complications in children with serious burn injuries. J Burn Care Rehabil. 1999, 20: 347-350. 10.1097/00004630-199909000-00001.CrossRefPubMed
83.
Sheridan RL: Burn care: Results of technical and organizational progress. JAMA. 2003, 290: 719-722. 10.1001/jama.290.6.719.CrossRefPubMed
Metadata
Title
Management of burn injuries – recent developments in resuscitation, infection control and outcomes research
Author
David J Dries
Publication date
01-12-2009
Publisher
BioMed Central
DOI
https://doi.org/10.1186/1757-7241-17-14

Other articles of this Issue 1/2009

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2009 Go to the issue

Case report

Management of a massive thoracoabdominal impalement: a case report

Review

Emergency presentation and management of acute severe asthma in children

Review

A systematic review of controlled studies: do physicians increase survival with prehospital treatment?

Case report

Necrotizing Fasciitis of the lower extremity: a case report and current concept of diagnosis and management

Review

Management of the critically poisoned patient

Commentary

Trauma and the acute care surgery model – should it embrace or replace general surgery?