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Focusing burn care in centers with an entire team dedicated to the burn patient has resulted in burn research that has led to improved physical and psychosocial outcomes, fewer complications, better pain management strategies, and shorter lengths of hospital stay.
Airway evaluation and management strategies in patients with inhalation injury and/or a large thermal injury differ from nonburn patients.
Ventilator management strategies for burn patients must include the same ventilator-associated pneumonia (VAP) bundle and the daily sedation vacation to assess readiness for extubation that is used in nonburn patients. In addition, specific assessment of airway edema must be performed.
Burn shock is a physiologic insult combining hypovolemic and distributive shock. The optimal patient outcome is provided by proper fluid resuscitation using large bore peripheral intravenous access and urine output monitored by a Foley catheter.
Prophylactic systemic antibiotic therapy does not prevent systemic infection but daily wound cleansing with soap and water followed by topical antimicrobial therapy is efficacious.
Patients with burns >20% total body surface area who have a transpyloric feeding tube placed on admission and high-protein feedings continued throughout operative procedures have better wound healing and shorter length of hospital stay.
The primary goal for wound care is wound closure. Full-thickness burns should be excised within the first 7 days, and treated with autografting if appropriate or allografting/xenografting/dermal replacement therapy if the burn size is too great for immediate autografting.
Burn pain is best treated with intravenous opioids and longer acting analgesic agents. Anxiolytics should also be used to decrease pain and for procedures such as hydrotherapy.
Rehabilitation therapy begins at admission for optimal outcomes, including positioning, splinting, early mobilization even while on the ventilator, and strengthening to promote healing.
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The goal of this review is to provide an overview of some of the most important critical care issues and approaches that are unique to burn patients when compared to the general intensive care unit population. The critically burned patient differs from other critically ill patients in many ways, the most important being the necessity of a team approach to patient care. The burn patient is best cared for in a dedicated burn center where resuscitation and monitoring concentrate on the pathophysiology of burns, inhalation injury, edema formation, and potential complications associated with burn and inhalation injuries. Early operative intervention and wound closure, metabolic interventions, early enteral nutrition, and glucose control have led to continued improvements in outcome. Prevention of complications such as hypothermia, compartment syndromes, and contractures is part of burn critical care. While expert opinion may have been the driving force behind current burn care standards and guidelines, continuing research driven by level I data is the wave of the future in the care of the burn patient.
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Major strides in understanding the principles of burn care over the last half century have resulted in improved survival rates, shorter hospital stays, decreases in morbidity and ...