Abstract
As burn care has improved, patients with severe burn injury have had improved survival. However, severe burn injury requires care in specialized intensive care unit (ICU) due to the profound impact of burn injury on the body. Patients with burns >20% total body surface area (TBSA) require admission to a burn ICU because they are at risk for complications such as resuscitation failure, infection, sepsis, and multi-organ failure due to their injury. Some patients with smaller burns also require ICU care because of significant medical comorbidities or either very young or advanced age. This chapter will address some of the special concerns in caring for severe burns in the ICU. Derangements to the cardiac, pulmonary, and renal system will be discussed as well as the body’s response to injury. Complications such as sepsis and renal failure will be reviewed. Finally, goals of care and palliative care will be addressed. Many topics discussed in this chapter are reviewed in more extensive details in other chapters.
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References
Pruitt BA, Wolf SE. An historical perspective on advances in burn care over the past 100 years. Clin Plast Surg. 2009;36(4):527–45. https://doi.org/10.1016/j.cps.2009.05.007.
Guzman EP, Oropello JM. Critical care of burn patients. In: Oropello JM, Pastores SM, Kvetan V, editors. Critical care. New York: McGraw-Hill Education; 2022. http://accessmedicine.mhmedical.com/content.aspx?aid=1136417932.
Wurzer P, Culnan D, Cancio LC, et al. Pathophysiology of burn shock and burn edema. In: Total burn care. 5th ed. Amsterdam: Elsevier Inc.; 2018. p. 66–76.e3. https://doi.org/10.1016/B978-0-323-47661-4.00008-3.
Cancio LC, Bohanon FJ, Kramer GC. Burn resuscitation. In: Total burn care. 5th ed. Amsterdam: Elsevier; 2018. p. 77–86.e2. https://doi.org/10.1016/B978-0-323-47661-4.00009-5.
Latenser BA. Critical care of the burn patient. Crit Care Med. 2010;38(4):1225–6. https://doi.org/10.1097/ccm.0b013e3181d453fd.
Woodson LC, Sherwood ER, Kinsky MP, et al. Anesthesia for burned patients. In: Total burn care. 5th ed. Amsterdam: Elsevier Inc.; 2018. p. 131–157.e4. https://doi.org/10.1016/B978-0-323-47661-4.00013-7.
Walker PF, Buehner MF, Wood LA, et al. Diagnosis and management of inhalation injury: an updated review. Crit Care. 2015;19(1):1–12. https://doi.org/10.1186/s13054-015-1077-4.
Fan E, Brodie D, Slutsky AS. Acute respiratory distress syndrome advances in diagnosis and treatment. JAMA J Am Med Assoc. 2018;319(7):698–710. https://doi.org/10.1001/jama.2017.21907.
Demling RH. Burns and other thermal injuries. In: Doherty GM, editor. Current diagnosis and treatment: surgery. New York: McGraw-Hill Education; 2015. http://accessmedicine.mhmedical.com/content.aspx?aid=1105485667.
Cambiaso-Daniel J, Gallagher JJ, Norbury WB, et al. Treatment of infection in burn patients. In: Total burn care. 5th ed. Amsterdam: Elsevier Inc.; 2018. p. 93–113.e4. https://doi.org/10.1016/B978-0-323-47661-4.00011-3.
Raes K, Blot K, Vogelaers D, et al. Protective isolation precautions for the prevention of nosocomial colonisation and infection in burn patients: a systematic review and meta-analysis. Intensive Crit Care Nurs. 2017;42:22–9. https://doi.org/10.1016/j.iccn.2017.03.005.
Rafla K, Tredget EE. Infection control in the burn unit. Burns. 2011;37(1):5–15. https://doi.org/10.1016/j.burns.2009.06.198.
Greenhalgh DG, Saffle JR, Holmes JH, et al. American burn association consensus conference to define sepsis and infection in burns. J Burn Care Res. 2007;28(6):776–90. https://doi.org/10.1097/BCR.0b013e3181599bc9.
Shan J, Chen HL, Zhu JH. Diagnostic accuracy of clinical pulmonary infection score for ventilator-associated pneumonia: a meta-analysis. Respir Care. 2011;56(8):1087–94. https://doi.org/10.4187/respcare.01097.
Clark A, Imran J, Madni T, et al. Nutrition and metabolism in burn patients. Burn Trauma. 2017;5(1):1–12. https://doi.org/10.1186/s41038-017-0076-x.
Porter C, Tompkins RG, Finnerty CC, et al. The metabolic stress response to burn trauma: current understanding and therapies. Lancet. 2016;388(10052):1417–26. https://doi.org/10.1016/S0140-6736(16)31469-6.
Carson JS, Goverman J, Fagan SP. Acute renal failure in association with thermal injury. In: Total burn care. 5th ed. Amsterdam: Elsevier Inc.; 2018. p. 318–327.e2. https://doi.org/10.1016/B978-0-323-47661-4.00031-9.
Hussain A, Choukairi F, Dunn K. Predicting survival in thermal injury: a systematic review of methodology of composite prediction models. Burns. 2013;39(5):835–50. https://doi.org/10.1016/j.burns.2012.12.010.
Williams DJ, Walker JD. A nomogram for calculation of the revised Baux score. Burns. 2015;41(1):85–90. https://doi.org/10.1016/j.burns.2014.05.001.
Pham TN, Otto A, Young SR, et al. Early withdrawal of life support in severe burn injury. J Burn Care Res. 2012;33(1):130–5. https://doi.org/10.1097/BCR.0b013e31823e598d.
Bartley CN, Atwell K, Cairns B, et al. Predictors of withdrawal of life support after burn injury. Burns. 2019;45(2):322–7. https://doi.org/10.1016/j.burns.2018.10.015.
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Hunter, M., Harrington, D.T. (2023). ICU Care of Burn Patients. In: Lee, J.O. (eds) Essential Burn Care for Non-Burn Specialists. Springer, Cham. https://doi.org/10.1007/978-3-031-28898-2_14
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DOI: https://doi.org/10.1007/978-3-031-28898-2_14
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