Critical care of thermally injured patient

Abstract

Only a minority of burn injured patients will require intensive care unit (ICU) admission and treatment. A burn is considered “major” when involving more than 20 % BSA, with further severity steps at 40 % and 60 % TBSA, the later being called massive burn injury. The presence of inhalation injury will have further additive affects increasing the mortality. Major burns impact the function of all organs: the massive release of pro-inflammatory mediators and lipid peroxides by the thermally injured skin will induce oxidative stress and inflammatory responses, which in turn cause cardiovascular, respiratory, digestive, renal, endocrine, and metabolic alterations. All these responses are proportional to the severity of the injury. Age and presence of co-morbidities are important prognostic factors, even more than in any other critical care condition. The massively burned patient poses one of the greatest challenges in critical care. While patients with severe thermal injury share several characteristics with other critically ill patients, there are significant differences.