Critical care management in burns: A review of current evidence and guidelines -Part 1

Abstract

Recent literature on the management of critically ill patients have altered the beliefs and clinical behaviours, questioning many dogmas that were practiced without much evidence. The critical care in a severely burn-injured patient requires special attention in resuscitation, haemodynamic monitoring, management of complications, organ support and determinants of outcome. The goal of resuscitation is to maintain intravascular volume and tone while correcting the reversible changes in altered physiology, aided by early debridement of burned tissue and elimination of the source of physiological derangement. Practitioners should target resuscitation based on goal-directed therapy using noninvasive markers of cardiac output. The management requires the input of a multidisciplinary team to achieve critical care and early surgical intervention and management of complications and organ support. Methods We performed a literature search on PubMed and Google Scholar, and looked for published original articles, review articles and guidelines on critical care management in burns, up to November 2019. Our search was limited to articles in English. Correspondence, dissertations and unpublished materials were not considered. The information were summarised and presented qualitatively (narratively) under subheadings. Contents: Fluid resuscitation in severe burns Goal-directed fluid therapy and Haemodynamic monitoring Evidence on choice of fluid for resuscitation Management of coagulopathy in severe burns Thromboprophylaxis in burns The role of suppressing hypermetabolism in severe burns Glycaemic control in severe burns Nutritional support in severe burns Sepsis and infection control in burns Management of inhalational injuries and acute respiratory distress syndrome (ARDS) Early surgical debridement and soft tissue cover Pain management in severe burns Palliative care in severe burns