Burn intensive care treatment over the last 30 years: Improved survival and shift in case-mix |
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Authors: | Rolf K Gigengack Margriet E van Baar Berry I Cleffken Jan Dokter Cornelis H van der Vlies |
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Institution: | 1. Department of Trauma and Burn Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands;2. Department of Anesthesiology, Amsterdam UMC, Location VU Medical Center, Boelelaan 1117, 1081HV Amsterdam, The Netherlands;3. Association of Dutch Burn Centers, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands;4. Department of Public Health, Erasmus MC, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands;5. Department of Intensive Care Medicine, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands;6. Trauma Research Unit Department of Surgery, Erasmus MC, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands |
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Abstract: | PurposeMortality in burn intensive care unit (ICU) has been decreasing and treatment appears to be changing. The aims of this study: (1) examine outcome in burn patients, (2) examine changes in ICU indication and (3) explore the influence of a changing case-mix.MethodsRetrospective study in patients admitted to ICU (1987–2016). Four groups were specified: major burns (≥15% TBSA), inhalation injury with small injury (<15% TBSA, inhalation injury), watchful waiting (<15% TBSA, without inhalation injury), tender loving care (patients withheld from treatment). Logistic regression was performed to evaluate the relation between case-mix and outcome.ResultsOverall mortality decreased to 7%. Mortality of major burns decreased by 15%. The major burn group decreased by 36%. The inhalation injury and watchful waiting group increased by 9% and 21%. The percentage of ventilated patients increased by 14% in the major burn group. 40% of patients were ventilated in the watchful waiting group.ConclusionsAfter correction for case-mix, survival improved, mainly in the major burn group. Case-mix shifted towards inhalation injury and watchful waiting. Growth of the watchful waiting group is not necessarily harmful. However, the increase of mechanical ventilation could be. We suggest raising awareness for risks and consequences of mechanical ventilation. |
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Keywords: | %TBSA percentage of total body surface area ABA American Burn Association ATLS advanced trauma life support BICU burn intensive care unit EMSB European Management of Severe Burns ICU intensive care unit ISBI International Society of Burn Injuries LOS length of stay LOS ICU length of stay intensive care unit RBAUX revised BAUX-score SDD selective digestive decontamination TBSA total body surface area TLC tender loving care Intensive care Burn injury Treatment Inhalation injury Mortality Length of stay |
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