Anaesthesia and intensive care for major burns

Abstract

Major burns are systemic injuries requiring input from multiple specialities. There are 140 000 cases of new burns per year presenting to emergency departments in England and Wales, with around 10% of these being admitted to hospital. Of these, 4000–5000 cases are complex and require the services of a regional adult burns unit. The majority of the others will be managed by hospitals with a plastic surgery service. Important considerations in the clinical outcome for these patients are early resuscitation, multidisciplinary team management, early surgical debridement, and prevention of complications. Anaesthesia in this group of patients can be challenging with profound hypermetabolism, pain management issues, alteration of drug pharmacokinetics, potential airway problems, temperature control, and substantial blood loss. Overall, the mortality rate among hospitalized burn patients in a recent review of European data was 13.9% (4–28.3%). Major risk factors for death are older age, a higher total percentage of burned surface area, inhalation injury [mortality rate 27.6% (7.8– 28.3%)], and chronic diseases. There appears to be no sex-related difference in survival after thermal injury. Multi-organ failure and sepsis are the most frequently reported causes of death. The main causes of early death (,48 h) are burn shock and inhalation injury.