Trauma’12 Runner-up Abstract - Factors Affecting Survival in Adult Critically Ill Severe Burn Patients

Abstract

Acute burns are relatively common. The incidence, outcomes, and factors related to mortality need to be identified in order to create a useful guideline. The purpose of this study was to define the factors that affect mortality and outcome of burns patients treated in the intensive care unit (ICU). In this study, 47 cases between November 2004 and August 2012 were included. Patients less than 16 years of age (n = 26) were excluded. Studied variables were age, burn ratio, degree of burn, APACHE II score, Glasgow Coma Scale (GCS), length of stay (LOS) in ICU, airway condition on arrival to ICU, albumin level at admission, arrival time to ICU, mechanical ventilation (MV) time if done, crystalloid and colloid levels given to the patient in ICU. Additionally, interventions during the stay such as central venous catheter (CVC), intravenous arterial catheter (IAC), Foley catheter, intubation, and nasogastric tube (NGT) were recorded. These variables were compared with survival for patients. Fluid resuscitation was managed using the Parkland Formula. We compared factors which might have an effect on survival for burn patients in the ICU. The mean burn ratio of patients who did not survive was 53.5%, this compared to 33.4% for the patients who survived (p = 0.038). The mean GCS for patients who survived and died were 13.43 and 9.79, respectively (p = 0.01). The mean APACHE II scores for non-surviving and surviving patients were 21.29 and 15.43, respectively (p = 0.03). The mean mechanical ventilation time for patients who survived and died were 20.57 and 106.67 hours respectively (p = 0.025). The mean albumin levels at admission for surviving and non-surviving patients were 2.81 and 2.26 g/dl respectively (p = 0.014). Factors that showed no significant relationship to survival included: amount of crystalloid or colloid solutions provided (p = 0.674 and p = 0.298 respectively), arrival time to ICU (p = 0.478), length of stay in ICU (p = 0.475), degree of burn (p = 0.110), and the mean age of the patient on admission(p = 0.911). Because of burns related to jugular region, five dead patients could not have CVC and NGT, as interventions needed. GCS, APACHE II score, burn ratio, MV time, and albumin levels at admission are significant markers of likely survival in burns patients treated in ICU. In all deceased patients, intubation was undertaken, but was ineffective. The width of the area burned and the region of burn both highly affected the interventions undertaken.