Ten tips for managing critically ill burn patients: follow the RASTAFARI!

Excerpt

Critically ill burned patients experience intensive injury associated with severe cardiovascular, immune, and metabolic disturbances. Management of severely burned patients remains challenging for many intensivists who only rarely face burn injuries. Together with pain and anesthetic management a multidisciplinary approach is needed in which anesthesiologists, intensivists, and surgeons play a central role. A critically ill burned patient could be defined as a burn patient with occurrence of organ dysfunction and/or requiring organ support. Adult patients with a total body surface area (TBSA) greater than 20 %, children with a TBSA greater than 10 %, or patients with inhalation injury are at most risk of developing organ dysfunction. Although specialized care is mandatory, all intensivists have already faced, or will, a patient with severe burn injury in its initial management before transferring the patient to a burn center. In this way, key factors of initial burn care should be known by all intensivists. Well-powered and designed randomized controlled trials are lacking for most strategies or treatments in burn care and most recommendations are based on observational data and/or expert opinions. However, many strategies remain controversial with clinical and pathophysiological questions being unanswered. …