Abstract
IntroductionBurn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve remote organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage soft tissue problems outside thermal injury including soft tissue infection and Toxic Epidermal Necrolysis.MethodsA selected review of recent reports published by the American Burn Association is provided.ResultsThe burn-injured patient is easily and frequently over resuscitated with complications including delayed wound healing and respiratory compromise. A feedback protocol is designed to limit the occurrence of excessive resuscitation has been proposed but no new "gold standard" for resuscitation has replaced the Parkland formula. Significant additional work has been included in recent guidelines identifying specific infectious complications and criteria for these diagnoses in the burn-injured patient. While new medical therapies have been proposed for patients sustaining inhalation injury, a new standard of medical therapy has not emerged. Renal failure as a contributor to adverse outcome in burns has been reinforced by recent data generated in Scandinavia. Of special problems addressed in burn centers, soft tissue infections and Toxic Epidermal Necrolysis have been reviewed but new treatment strategies have not been identified. The value of burn centers in management of burns and other soft tissue problems is supported in several recent reports.ConclusionRecent reports emphasize the dangers of over resuscitation in the setting of burn injury. No new medical therapy for inhalation injury exists but new standards for description of burn-related infections have been presented. The value of the burn center in care of soft tissue problems including Toxic Epidermal Necrolysis and soft tissue infections is supported in recent papers.
Highlights
Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners
A feedback protocol is designed to limit the occurrence of excessive resuscitation has been proposed but no new "gold standard" for resuscitation has replaced the Parkland formula
While new medical therapies have been proposed for patients sustaining inhalation injury, a new standard of medical therapy has not emerged
Summary
Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Contemporary discussion of burn resuscitation features the Parkland formula proposed by Baxter and coworkers in the 1960s.[2] Reviews of recent experience with burn resuscitation suggest that treatment objectives and fluids administered in the approach recommended by the Parkland group are frequently exceeded.[3] What is contemporary thinking about initial fluid administration in the setting of burn injury? The American Burn Association (ABA) has recently presented a statement which begins to answer this question.[4] The Parkland Burn Center recently published a report on the use of the Parkland formula in the institution where it originated.[5] Sepsis presents in non-traditional ways in the burn-injured patient.[1] I have summarized, for the non-burn physician and surgeon some of the key aspects of a recent consensus statement produced by the American Burn Association about organ-specific septic complications in the setting of burn injury
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