Abstract
The treatment and management of massive burns, defined as burns affecting at least 50% of total body surface area (TBSA), have considerably changed since the 1990s. This study aimed at analyzing if the length of intensive care unit (ICU) stay, the success of skin grafting operations, and the mortality changed in the past 18 years. Between 2000 and 2018, 77 patients were admitted for massive burns to the ICU of a university hospital. Transfers and early care withdrawal precluded inclusion for 38 patients, leaving 39 for analysis. Study variables were year of admission, demographics, burn characteristics, critical care treatment (fluid resuscitation, ventilation, and nutrition), and surgical therapy. Association between outcomes and year of admission was assessed through correlation and logistic regression analysis. Potential confounders were assessed through stepwise linear regression. Patients’ characteristics were stable over time with a median age of 36 (25.0–48.0) years, burns 65% (55.0–83.0) TBSA, and deep burns 55% (50.0–68.0) TBSA. Length of ICU stay remained stable at 0.97 (0.6–1.5) days/%TBSA. Mortality was stable as well. Energy and carbohydrate delivery decreased in parallel with the number of infectious episodes per patient. The number of operations was stable, but the take rate of skin grafts increased significantly. The multivariate analysis retained year of admission, weight, the total number of infections, daily lipid intakes, and fluid resuscitation as independent predicting variables.
Highlights
Burns are a frequent trauma with an estimated incidence of 9 million cases per year worldwide and a prevalence of 90 million cases in 2017.1 The vast majority are benign cases as the area affected and/or the depth of the injury are limited
In this review of the massively burned patients treated at Lausanne University Hospital burn intensive care unit (ICU), we investigated whether the length of ICU (LICU) stay, the success of skin grafting operations, and the mortality changed between 2000 and 2018
Patients All adult patients (>18 years old) with burns at least 50% total body surface area (TBSA) admitted in the burn ICU of the Lausanne University Hospital were included in this study
Summary
Burns are a frequent trauma with an estimated incidence of 9 million cases per year worldwide and a prevalence of 90 million cases in 2017.1 The vast majority are benign cases as the area affected and/or the depth of the injury are limited. The incidence of severe burns, usually defined as burns more than 20% of total body surface area (TBSA) in adults and/or by the need of specialized burn intensive care units (ICUs) treatment,[2,3] is not precisely known, but estimates range from 160,000 to 2.3 million cases per year worldwide.[4] Massive burns are a more imprecise term, with. From the *Department of Plastic and Hand Surgery, Lausanne University Hospital, Switzerland; †Department of Adult Intensive Care Medicine and Burns, Lausanne University Hospital, Switzerland; ‡Cell Production Center, Lausanne University Hospital, Switzerland
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