Current Opinion in Critical Care vol:18 issue:6 pages:671-676
PURPOSE OF REVIEW:
To summarize and highlight recent advances in the understanding and management of burn injuries.
The review focuses on topics which are of particular relevance for critical care practitioners involved in burn care: resuscitation, management of infection and sepsis, epidemiology and outcome, and organization and costs of burn care.
While being the mainstay of early survival in burn victims, various aspects of burn resuscitation are still contentious and highlighted in this review. In particular, several strategies to overcome the repeatedly observed 'fluid creep' in burn patients are discussed, including the use of computerized resuscitation algorithms and the administration of colloids. Sepsis and multiorgan failure have become the major causes of death in patients surviving the initial phase of burn shock. Various aspects of sepsis management are reviewed, amongst which diagnosis, antibiotic treatment and prophylaxis. Recent epidemiologic data allow to identify risk factors associated with mortality as these are potentially amenable to targeted prevention and therapy. Examples are acute kidney injury and sepsis. The overview is completed by recent findings on organization and costs of burn care, including the adherence to referral criteria and the main determinants of cost.