Full-thickness Total Body Surface Area Research Articles

A Regional Analysis of Potentialy Preventable Injuries Sustained from Burning Garbage and Yard Waste.

Due to high prevalence in the south, understanding the injury pattern, healthcare burden, and cost of burn injuries associated with burning yard and trash debris are important for effective prevention. This five-year retrospective, single-center study included patients sustaining an open flame burn injury due to burning brush or trash. Based on primary residence of the 136-patients, 56% had access to free municipal waste disposal, 25% could have had access with additional payment, and 18% did not have access. The median (Q1, Q3) age and total body surface area (TBSA) burned was 50 (32, 66.5) years and 5% (2.5, 12), respectively, with 36% having some portion of full-thickness injury. One-third had some form of substance use. There were 151 total operations with a median of 1 (0, 1.5) per patient. There were 1,620 hospital days utilized (~6.6% of available bed-days per study period). Twenty-five percent were discharged with a paired functional status worse than pre-injury. Patients with some degree of pre-injury function limitations had a three-fold higher length of stay (10 vs 3 days; p = 0.023). Patients with lower pre-injury functionality had almost 4 times higher mortality (23.7% vs 6.3%; p = 0.085). There were 9 (6.7%) deaths with an average (± SD) 74.3 ± 13.1 years of age, median 33% (31, 43) TBSA, and median full-thickness TBSA of 32% (21, 44). Total hospital charges exceeded $32.6 million with a median $32,952.26 ($8,790.48, $103,113.95) per patient. Focusing future outreach efforts on education and resource availability may prevent future waste burning injuries.

Incidence and predictors of perioperative atrial fibrillation in burn intensive care unit patients following burn surgery

BackgroundAtrial fibrillation is a well-documented complication following cardiac surgery. It is associated with increased inpatient and long-term mortality. There have been few prior studies on perioperative atrial fibrillation following burn surgery in severely burned patients. The purpose of this study was to identify the incidence, predictors, and prognosis of perioperative atrial fibrillation after burn surgery in severely burned patients. MethodsPatients aged older than 18 years with 30% burned total body surface area (TBSA) were enrolled in this study. Patients who had a previous history of atrial fibrillation or atrial fibrillation on the preoperative electrocardiogram were excluded. We reviewed medical records retrospectively, and the data of 214 patients were studied. ResultsA total of 214 critically ill burned patients and 1132 operations were available for analysis during the 5-year study period; 12 (1.1%) patients were diagnosed with newly developed atrial fibrillation after a burn operation, of whom 4 patients showed paroxysmal atrial fibrillation (all related to surgical stimulation) and none changed to persistent atrial fibrillation. The incidence of perioperative atrial fibrillation was associated with TBSA%, full-thickness TBSA%, and hypertension. Multiple logistic regression analysis indicated that TBSA% (OR=13.851, P < 0.001) and full-thickness TBSA% (OR=15.223, P = 0.018) were independent predictors for developing perioperative atrial fibrillation. All of our patients had at least one risk factor, with blood volume variation or burn sepsis occurring most commonly. Perioperative atrial fibrillation developed after a median of 0 days after burn surgery. Three patients died, and the causes of death were noncardiovascular events such as sepsis and multiple organ failure. ConclusionAtrial fibrillation was a relatively rare complication among severely burned patients admitted to surgery and was associated with TBSA% and full thickness TBSA%. All of our patients exhibited at least one of the modifiable risk factors for atrial fibrillation, confirming the importance of optimization of electrolytes and fluid status and limitation of sympathetic activation.

718 Indirect Calorimetry is Necessary to Optimize Nutrition in Large Burns

IntroductionAssessing nutritional requirements in large total body surface area (TBSA) burns is a challenge due to frequent metabolic variation. Studies have compared indirect calorimetry (IC) with predictive equations and identified formulas that are frequently used in the absence of IC. Large TBSA burns remain poorly understood, as does the role of changing metabolic rate and multiple surgical procedures over the course of recovery. We sought to understand whether these equations remain reliable in these situations.MethodsThe patient is a 31 year old, 92% full-thickness TBSA burn who was studied over the first 75 days of hospitalization at various points per institutional IC guidelines. Using total energy expenditure (TEE) by IC as the standard, we assessed variation of each predictive equation for accuracy. Only the Milner and Toronto formulas are dynamic, and we analyzed variation by post-burn day (PBD) compared to dates of major surgical procedures in these studies. The patient was excised on PBD 1, 2, 5, 7, 9, 21, and 25; he was grafted on POD 5, 11, 20, 41, and 56. Weekly monitoring of prealbumin and CRP indicated adequate nutrition.ResultsOn post-burn day (PBD) 5, when all major burns were excised, all predictive equations inappropriately estimated the patient’s energy expenditure. On longitudinal analysis of 16 IC studies (Table 2), the Milner equation was most accurate, estimating within 5% variance of TEE at 5 time points (31%). The Toronto formula did not estimate within 5% variance at any time point. No energy equation consistently and accurately estimated energy expenditure over all calculated time points.ConclusionsAlthough predictive equations are frequently used, in high TBSA burns with many operations and changing nutritional needs, equations are not as accurate as IC. Given that over- or under-estimating needs result in many complications avoided with IC, we propose frequent IC for intubated, high TBSA patients.

Geriatric Burn Injuries: Prevalence, Management and Clinical Outcome

Burns are a significant public health issue that result in more than 180 000 fatalities annually. For specialized burn care, the geriatric burn population is a sensitive and usually challenging group. Despite the fact that all age groups have shown advances in burn care, geriatrics still have worse survival rates. Burn severity, treatment, and outcomes are impacted in geriatrics because of the physiological differences between them and younger adult burn patients. The atrophic skin of the elderly results in deeper burns, or a higher ratio of full-thickness total body surface area compared to younger patients, but it also hinders the healing of both donor sites and burns. The purpose of this research is to review the available information about geriatric burn injuries: prevalence, management and clinical outcome. Elderly people are more susceptible to complications such pneumonia, congestive heart failure, and pulmonary edema. The morbidity and mortality seen in geriatric burn patients are also attributed to altered immunological and inflammatory response driven by age leading to increased hospital stays and more severe complications. Management of geriatric burn patients involves two concepts. the revolutionary theory of eschar excision and wound closure within the first week of hospitalization, and the conventional strategy of reducing physiologic stress by delaying surgery in the early post-burn stage while the development of effective fluid resuscitation protocols, which has most significantly boosted patient survival, is one of the pillars of modern burn care. The epidemiology of burn injuries in geriatrics is quite variable and demands further research.

Clinical outcome and comparison of burn injury scoring systems in burn patient in Indonesia.

IntroductionThe purpose of this study was to explore and compare the performance of four burn injury scoring systems in Indonesia. In a retrospective study, data of all burn patients admitted to the emergency centre (EC) were collected. The following clinical outcome and four burn injury scoring systems were used to assess each patient: Abbreviated Burn Severity Index (ABSI), Belgian Outcome in Burn Injury (BOBI), the Ryan model, and revised Baux Score.MethodsFrom April 2017 to April 2018, clinical outcome and burn injury score for every admitted patient were calculated to evaluate burn prognosis. Demographic information, ABSI score, full-thickness total body surface area (TBSA), overall TBSA, hospital stay, and inhalation injury were noted for analysis. Discriminative ability and goodness-of-fit of the prediction models were determined by receiver operating characteristic curve analysis and Hosmer–Lemeshow tests.ResultsWe included 72 patients (mean age: 40.79 ± 16.30 years, average TBSA: 23.59% ± 24.84). Only 1 (1.4%) of them was diagnosed with inhalation injury. Mortality rate was 25%. Deceased patients had significantly higher mean age, %TBSA, and number of inhalation injuries. The ABSI model with sensitivity was 81.6, specificity was 92.5, accuracy was 87.3 and under the Receiver Operator Characteristics curve (AUC) was 0.93 (SE = 0.03).ConclusionsThe best estimation of predicted mortality was obtained with the ABSI model.

Clinical characteristics and risk factors for severe burns complicated by early acute kidney injury.

Early acute kidney injury (AKI) is a frequent fatal complication of severely burned patients. Although significant progress has been made in fluid resuscitation, intensive care, and renal replacement therapy (RRT) technology in recent years, the incidence and mortality rate in severely burned patients with AKI remains considerable. This study aims to provide theoretical evidence for prevention and treatment by investigating the clinical characteristics and risk factors influencing the incidence and severity of early AKI in severely burned patients. This 3-year retrospective, single-center study was conducted in critically ill burned patients admitted to the Burn ICU at Guangzhou Red Cross Hospital of Jinan University. Patients whose age is older than 18 years with ≥30% burned total body surface area (TBSA) were enrolled in this study. Those patients who arrived at our burn ICU>72h after injury or died within 48h from arrival were excluded. Data of 128 patients were studied in the final. Demographic and injury details were recorded. KDIGO criteria were used to assess the incidence and severity of early AKI. Factors influencing early AKI were determined using univariate and multiple logistic regression analysis. Between January 2016 and December 2018, Data from 128 critically ill burned patients were available for analysis. The median age was 44.9±16.8 years; 68.8% of the patients were male. The median TBSA% was 60 (IQR, 41.3-80%). According to the KDIGO criteria, 36 patients (28.3%) developed early AKI, as follows: stage 1 AKI, 69.4% (25/36); stage 2 AKI, 13.9% (5/36); and stage 3 AKI, 16.7% (6/36). The incidence of early AKI was associated with TBSA%, full-thickness TBSA%, abbreviated burn severity index on admission (ABSI), inhalation injury, mechanical ventilation, cardiovascular complications, and rhabdomyolysis. Multiple logistic regression analysis indicate that TBSA% (OR=0.224, p=0.007), full-thickness TBSA% (OR=0.254, p=0.014), ABSI (OR=18.326, p=0.009), and rhabdomyolysis (OR=24.036, p=0.000) were independent risk factors for the occurrence of early AKI. Significant factors influencing the severity of early AKI included full-thickness body surface area burns, electrical burns, and rhabdomyolysis. Full-thickness TBSA% (OR=1.437, p=0.041) and rhabdomyolysis (OR=5.401, p=0.035) are associated with mortality. The risk of death due to the occurrence of AKI was 5.407 in the Cox model adjusted for TBSA%, full-thickness body surface area burns, ABSI and rhabdomyolysis. Three patients died, all of whom had stage 3 AKI, accounting for 8.3% (3/36) of AKI patients. The death rate of stage 3 AKI who did and did not receive early RRT was 33.3% and 66.7%, respectively. Rhabdomyolysis is an independent risk factor for early AKI and closely related to the severity of early AKI in critically ill burned patients. Although with a high incidence of early AKI in severely burned patients, most of them are mild. Early adequate fluid resuscitation, timely and effective escharotomy, reducing the incidence and severity of rhabdomyolysis, most of them can achieve a relatively good prognosis.

Stratification of venous thromboembolism risk in burn patients by Caprini score

BackgroundThe purpose of the research was to determine the efficacy of the Caprini risk assessment model for the guidance of prophylactic treatments for a 3-year period in the burn center of the Inner Mongolia region. MethodsFrom July 2014 to August 2017, the Caprini score for every admitted patient was calculated to evaluate venous thromboembolism (VTE) risk. Subjects with a Caprini score between 0 and 2 were not administered a chemical VTE prophylaxis, and subjects with a score of 3 and above were administered low-molecular-weight heparin (LMWH). Demographic information, abbreviated burn severity index (ABSI) score, body mass index (BMI), Caprini score, full-thickness total body surface area (TBSA), overall TBSA, day of ambulation, hospital stay, inhalation injury, electrical burn, central venous catheters, and operations were noted for analysis. ResultsOf 1939 inpatients during the study period, 13 patients (0.67%) had VTE complications. The interval from injury to VTE diagnosis was 13.9±8.7 days. Among patients (n=1131) with a Caprini score between 0 and 2, two patients (0.18%) had VTE. A total of 792 patients received LMWH thromboprophylaxis; 11 patients had VTE complications, and among them, one patient (0.13%) developed heparin-induced thrombocytopenia and two patients (0.25%) developed major bleeding. VTE (8.82%) occurred most commonly in the Caprini score >8 group. Age, Caprini score, ABSI score, overall and full-thickness TBSA, central venous catheters, day of ambulation, and hospital stay in patients with VTE (n=11) were significantly higher than those (n=781) without VTE (p<0.05). ConclusionsCaprini score allows for informed decision-making regarding prophylaxis strategies. Early ambulation and mechanical prophylaxis are recommended for patients predisposed to VTE.

Blood transfusions in severe burn patients: Epidemiology and predictive factors

BackgroundBlood is a vital resource commonly used in burn patients; however, description of blood transfusions in severe burns is limited. The purpose of this study was to describe the epidemiology of blood transfusions and determine factors associated with increased transfusion quantity. MethodsThis is a retrospective study of total 133 patients with >40% total body surface area (TBSA) burns admitted to the burn center of Changhai hospital from January 2008 to December 2013. The study characterized blood transfusions in severe burn patients. Univariate and Multivariate regression analyses were used to evaluate the association of clinical variables with blood transfusions. ResultsThe overall transfusion rate was 97.7% (130 of 133). The median amount of total blood (RBC and plasma), RBC and plasma transfusions was 54 units (Interquartile range (IQR), 20–84), 19 units (IQR, 4–37.8) and 28.5 units (IQR, 14.8–51.8), respectively. The number of RBC transfusion in and outside operation room was 7 (0, 14) and 11 (2, 20) units, and the number of plasma was 6 (0.5, 12) and 21 (11.5, 39.3) units. A median of one unit of blood was transfused per TBSA and an average of 4 units per operation was given in the series. The consumption of plasma is higher than that of RBC. On multivariate regression analysis, age, full-thickness TBSA and number of operations were significant independent predictors associated with the number of RBC transfusion, and coagulopathy and ICU length showed a trend toward RBC consumption. Predictors for increased plasma transfusion were female, high full-thickness TBSA burn and more operations. ConclusionsSevere burn patients received an ample volume of blood transfusions. Fully understanding of predictors of blood transfusions will allow physicians to better optimize burn patients during hospitalization in an effort to use blood appropriately.

Burns in older people. Epidemiology, surgical management and outcome in a university hospital referral burn unit, 1994–2004

BackgroundBurn injuries in older people are becoming more frequent as the population ages. Burn management in older people remains controversial. ObjectivesThe aim of this retrospective study was to describe the epidemiologic profile of older people in our university hospital burn unit, to report their surgical management, and to identify factors associated with the risk of death. MethodsWe included all patients aged 70years and over who were admitted between January 1994 and December 2004. ResultsThere were 84 men (43%) and 111 women (57%), with a median age of 79.0 (IQR 75.0–85.0) and a median total body surface area (TBSA)% of 12.3% (IQR 5.0–23.5). Most injuries occurred at home (85.1%). Most patients had pre-existing co-morbidities (78.5%). Conservative treatment was performed in 74 (37.9%) patients, while 121 (62.1%) patients underwent surgery. Early excision was performed in 17 (14.0%) patients, who were both significantly younger (P=0.02) and more severely burned (P=0.004). Forty-seven (24.1%) patients died in hospital. Factors associated with death were TBSA% (P<10−4), full-thickness TBSA% (P=0.0016), inhalation injury (P=0.02) and conservative treatment (P<10−4). The overall median length of hospital stay was 29.0 days (IQR 11.0–54.0, range 0.0–375.0). One-third of the 148 discharged patients were able to return home alone. ConclusionBurn prevention in older people, by adapting their daily living environment, is a major public health issue. Treatment modalities, i.e. conservative versus surgical, must be evaluated and planned specifically for each patient, depending on overall health status, which should ideally be assessed in collaboration with a geriatrician.

Poster 45: Functional Outcome in a Patient with 92 Percent Total Body Surface Area Full-Thickness Burns: A Case Report

Setting: Acute inpatient rehabilitation unit. Patient: 31-year-old man without medical history who sustained 92% full-thickness total body surface area (TBSA) burns secondary to flame-related injury. Case Description: The patient presented to the inpatient rehabilitation unit after surviving 92% TBSA full-thickness burns from a flame-related injury at work. During the patient's 4 month stay in the burn unit, he required pressor support and mechanical ventilation. He also underwent multiple skin grafts and debridements secondary to his severe burns. He was transferred to the acute inpatient rehabilitation unit 4 months after his original injury with a tracheostomy and percutaneous gastric tube. Assessment/Results: On admission to the rehabilitation unit, the patient was nonambulatory and was at a maximum assist level for transfers and self-care. He also remained nothing by mouth with bolus tube feeds. His wounds were aggressively managed and required dressing changes with each nursing shift. The patient was followed closely by all disciplines, including physical and occupational therapy, speech/language/pathology, psychology, wound care, and respiratory therapy. During his 57-day stay in the rehabilitation unit, the patient made significant progress. The patient was able to ambulate at a modified independent level within 4 weeks. Self-care skills improved slowly secondary to upper-extremity contractures. On discharge, the patient was minimum assist for upper-extremity dressing, set-up for feeding, and maximum assist for toileting and lower body dressing. Dysphagia improved and was upgraded to a mechanical soft diet with thin liquids on discharge to home. Conclusions: Survival rates for patients sustaining greater than 90% TBSA are low. According to the National Burn Repository Report of 2006, 74 cases in the 30 to 39 year-old age group were reported for full-thickness burns of 90% or greater, and of those 74 cases, 61 patients died. Current literature reveals that it is rare for a patient to sustain and survive greater than 90% TBSA full-thickness burn injury. Comprehensive inpatient rehabilitation is vital to burn-injured patients, providing a multi-disciplinary approach for patients to regain function and independence.

Continuous Renal Replacement Therapy Improves Survival in Severely Burned Military Casualties With Acute Kidney Injury

Acute kidney injury in severely burned patients is associated with high mortality. We wondered whether early use of continuous renal replacement therapy (CRRT) changes outcomes in severely burned military casualties with predetermined criteria for acute kidney injury. Between November 2005 and June 2007, casualties admitted to our burn intensive care unit after sustaining burns in Iraq and Afghanistan, who subsequently developed acute kidney injury or circulatory shock or both, underwent CRRT. Baseline demographic, laboratory, and hemodynamic parameters were recorded. Both 28-day mortality and in- hospital mortality were evaluated and compared with a consecutive group of burn casualties with greater than 40% total body surface area (TBSA) burns, acute kidney injury, or nephrology consultation in the 2 years before the existence of our CRRT program. One hundred forty-seven severely burned military casualties were admitted to our intensive care unit before CRRT program initiation, and 102 were admitted after CRRT program initiation. Before the CRRT program, 16 patients were identified as having >40% TBSA burns with kidney injury with or without nephrology consultation (control group); 18 were treated with CRRT since (CRRT group). Groups were similar for %TBSA, %full-thickness TBSA, incidence of inhalation injury, blood urea nitrogen, creatinine, and Injury Severity Score. Of the CRRT patients, seven soldiers were treated for isolated acute kidney injury, whereas 11 were treated for a combination of acute kidney injury and shock. The dose of therapy was 50.2 +/- 13 mL/kg/h with a treatment course of 5.2 +/- 3 days. Of the 11 patients in the CRRT group treated for shock, eight were off vasopressors by 24 hours and the remaining three within 48 hours. None of the patients in the control group were placed on renal replacement therapy with nephrology consultation in eight patients. Both 28-day mortality (22% vs. 75%, p = 0.002) and in-hospital mortality (56% vs. 88%, p = 0.04) were lower in the CRRT group compared with that in the control group. Aggressive application of CRRT in severely burned casualties with kidney injury significantly improves survival.

Joint Theater Trauma System Implementation of Burn Resuscitation Guidelines Improves Outcomes in Severely Burned Military Casualties

Between March 2003 and June 2007, our burn center received 594 casualties from the conflicts in Iraq and Afghanistan. Ongoing acute burn resuscitation as severely burned casualties are evacuated over continents is very challenging. To help standardize care, burn resuscitation guidelines (BRG) were devised along with a burn flow sheet (BFS) and disseminated via the new operational Joint Theater Trauma System to assist deployed providers. After the BRG was implemented in January 2006, BRF data were prospectively collected in consecutive military casualties with >30% total body surface area (TBSA) burns (BRG Group). Baseline demographic data and fluid requirements for the first 24 hours of the burn resuscitation were collected from the BFS. Percentage full thickness TBSA burns, presence of inhalation injury, injury severity score, resuscitation-related abdominal compartment syndrome, and mortality were collected from our database. Individual charts were reviewed to determine the presence of extremity fasciotomies and myonecrosis. These results were compared with consecutive military casualties admitted during the 2-year- period before the system-wide implementation of the BRG (control group). One hundred eighteen military casualties with burns >30% TBSA were admitted between January 2003 and June 2007, with n = 56 in the BRG group and n = 62 in the control group. The groups were different in age, but similar in %TBSA, %full thickness, presence of inhalation injury, and injury severity score. There was no difference in the rate of extremity fasciotomies or the incidence of myonecrosis between groups. The composite endpoint of abdominal compartment syndrome and mortality was significantly lower in the BRG group compared with the control group (p = 0.03). Implementation of the BRG and system-wide standardization of burn resuscitation improved outcomes in severely burned patients. Utilization of the joint theater trauma system to implement system-wide guidelines is effective and can help improve outcomes.

Platelet depletion in mice increases mortality after thermal injury

AbstractPlatelets play a fundamental role in maintaining hemostasis and have been shown to participate in innate and adaptive immunity. However, the role of platelets in the immune response to injury remains undefined. We tested the importance of platelets in the host response to serious injury in a newly developed platelet-deficient mouse model. Wild-type and platelet-depleted C57BL/6J mice underwent a 25% full-thickness total body surface area thermal or sham injury. Platelet-deficient mice showed survival of 51% at 48 hours after injury compared with 94% to 100% survival in experimental control mice (P < .001). Necropsy and histology ruled out hemorrhage and hypovolemia as causes of death. Percentages of peripheral blood monocytes (P < .01) and neutrophils (P < .05) were increased between 36 and 48 hours after thermal injury in platelet-deficient mice compared with control mice. Plasma levels of TNFα (P < .001), IL-6 (P < .001), and MCP-1 (P < .05) were also elevated by 24 hours whereas levels of TGFβ1 were reduced between 24 and 36 hours following injury in platelet-depleted mice (P < .001) compared with control mice. Our findings demonstrate for the first time that platelets play a critical protective role during the host response to injury. Moreover, our findings suggest that platelets and, more importantly, platelet-derived TGFβ1 modulate the systemic inflammatory response occurring after injury.

Plasma TGF-β 1 in thermally injured mice

Introduction. Severe thermal injury is commonly associated with two common complications: systemic inflammatory response syndrome (SIRS) and immune suppression. Both are implicated in the causation of multiple organ dysfunction syndrome (MODS). A previous study from our hospital showed that thermal injury induces a significant increase in serum TGF-β. In this study, we performed a time course analysis of serum TGF-β 1 following burn injury in mice. Methods. Female C57BL/6J mice, 6- to 8-weeks-old, received a 40% full-thickness total body surface area (TBSA) burn under 2.5% isoflurane inhalation anesthesia. They were resuscitated with Lactate Ringer’s solution 0.1 ml/g body weight intraperitoneally and Buprenorphine (2 mg/kg subcutaneously) immediately after burn. Sham mice were anesthetized and shaved but did not receive burn injury. Mice were sacrificed 3 h postburn as well as on days 1, 3, 5, 7, 10, and 14. Plasma was collected from all animals at sacrifice. Plasma TGF-β 1, IL-10, IL-6, and IFN-γ levels were assayed by ELISA. Data are expressed as means ± SEM, and statistical analysis was performed by one-way ANOVA. Statistical significance was accepted as P < 0.05. Results. Plasma TGF-β 1 was decreased at 3 h postburn (ANOVA P = 0.357; P < 0.05, peak versus nadir) compared to sham controls but returned to control levels by day 1 and peaked on postburn day 5. IL-10 and IFN-γ were not detectable in plasma at any time point after burn. Plasma IL-6 levels were increased at 3 h ( P < 0.05) after burn injury but returned to sham levels by 24 h after burn exposure and remained low from thereon. Conclusion. Thermal injury induces a significant alteration in plasma TGF-β 1, which may contribute to postburn systemic inflammatory response as well as immunosuppression with an increased susceptibility to sepsis. Our data suggest that TGF-β 1 plays an important regulatory role during both early and late phases of burn injury. Further, the initial drop in TGF-β 1 level followed by a late increase suggests its different roles in different phases of injury.

Determinants of mortality in pediatric patients with greater than 70% full-thickness total body surface area thermal injury treated by early total excision and grafting.

Recent advancements in burn care have improved the survival rates of victims with severe burn injuries. The total mortality rate in a series of 1,057 pediatric patients admitted to Shriners Burns Institute Galveston Unit between 1982 and 1986 was 2.7%. The burn size resulting in a 50% death rate was 95% of the total body surface area (TBSA). In this study 19 survivors and 13 nonsurvivors with greater than 70% full-thickness TBSA burn injuries were compared. All survivors were adequately resuscitated upon arrival 11% sustained an inhalation injury. Forty-six per cent of the nonsurvivors sustained an inhalation injury; 31% were not initially adequately resuscitated. The presence of preadmission shock and inhalation injury were early determinants of mortality with secondary renal, pulmonary, or cardiovascular collapse being the later predictors of mortality in these massively burned pediatric patients.

The effects of burn injury and fluid resuscitation on cardiac function in vitro.

The effects of a 30% full-thickness total body surface area scald burn on in vitro mechanical cardiac function was studied in Sprague-Dawley rats. The findings were a 50% decrease in tension development and velocities of contraction and relaxation, when papillary muscle functions from sham and unresuscitated burned animals were compared. Fluid resuscitation synchronous with burning completely reversed the defects in papillary muscle function. This defect in function was partially transferable to normal muscles incubated in serum from burned rats.