CURRENT TREATMENT OF SEVERELY BURNED PATIENTS

Objective The authors provide an update on a multidisciplinary approac h to the treatment of severely burned patients. A review of studies an d clinical trials from the past to the present include fluid resuscita tion, sepsis, immune function, hypermetabolism, early excision, wound healing, scar formation, and inhalation injury. Summary Background Dat a Advances in treating initial burn shock, infection control, early wo und closure, and modulation of the hypermetabolic response have decrea sed morbidity and mortality in the last two decades. Specialized burn care centers, using a multidisciplinary approach, not only successfull y treat large burns and their complications, but provide the necessary rehabilitation and psychological support required for readjustment ba ck into society. Conclusions Thermal injury results in a number of phy siologic alterations that can be minimized by adequate fluid resuscita tion to maintain tissue perfusion, early excision of burn wounds, and rapid wound coverage. These measures, in combination with antibiotic c overage and nutritional support in the form of early enteral tube feed ings, will decrease the hypermetabolic response and the incidence of s epsis that can lead to hemodynamic instability and organ failure. Ongo ing clinical trials using anabolic agents (e.g., recombinant human gro wth hormone) and pharmacologic agents that modulate inflammatory and e ndocrine mediators(e.g., ibuprofen and propranolol) show promise in th e treatment of severe burn injuries.