Characterization of critically ill adult burn patients admitted to a Brazilian intensive care unit |
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| Affiliation: | 1. Intensive Care Unit, Burn Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil;2. Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil;1. Injury Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland;2. Helsinki Burn Centre, Helsinki University Hospital, Helsinki, Finland;1. Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran;2. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran;1. Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran;2. Microbiology, Virology and Microbial Toxins Department, School of Medicine, Guilan University of Medical Sciences (GUMS), Rasht, Iran;3. Universal Scientific Education and Research Network (USERN), Microbial Toxins Physiology Group, Rasht, Iran;4. Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran;5. Department of Medical Physics, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran;6. Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran;7. Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran;1. Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands;2. Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands;3. Burn Centre, Martini Hospital, Groningen, The Netherlands;4. Department of Surgery, University Medical Centre Leiden, The Netherlands;5. Association of Dutch Burn Centres, Beverwijk, The Netherlands;6. Department of Plastic, Reconstructive and Hand Surgery, Research Institute MOVE, VU University Medical Centre, Amsterdam, The Netherlands;7. Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands;8. Department of Public Health, Erasmus MC, Rotterdam, The Netherlands;1. Firefighters'' Burn and Surgical Research Laboratory, MedStar Health Research Institute, USA;2. The Burn Center, Department of Surgery, MedStar Washington Hospital Center, USA;3. Department of Surgery, MedStar Georgetown University Hospital, USA |
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| Abstract: | IntroductionTo characterize the evolution of clinical and physiological variables in severe adult burn patients admitted to a Brazilian burn ICU, we hypothesized that characteristics of survivors are different from non-survivors after ICU admission.MethodsA five-year observational study was carried out. The clinical characteristics, physiological variables, and outcomes were collected during this period.ResultsA total of 163 patients required ICU support and were analyzed. Median age was 34 [25,47] years. Total burn surface area (TBSA) was 29 [18,43]%, and hospital mortality rate was 42%. Lethal burn area at which fifty percent of patients died (LA50%) was 36.5%. Median SAPS3 was 41 [34,54]. Factors associated with hospital mortality were analyzed in three steps, the first incorporated ICU admission data, the second incorporated first day ICU data, and the third incorporated data from the first week of an ICU stay. We found a significant association between hospital mortality and SAPS3 [OR(95%CI) = 1.114(1.062–1.168)], TBSA [OR(95%CI) = 1.043(1.010–1.076)], suicide attempts [OR(95%CI) = 8.126(2.284–28.907)], and cumulative fluid balance per liter within the first week [OR(95%CI) = 1.090(1.030–1.154)]. Inhalation injury was present in 45% of patients, and it was not significantly associated with hospital mortality.ConclusionsIn this study of an ICU in a developing country, the mortality rate of critically ill burn patients was high and the TBSA was an independent risk factor for death. SAPS3 at admission and cumulative fluid balance in the first seven days, were also associated with unfavorable outcomes. The implementation of judicious fluid management after an acute resuscitation phase may help to improve outcomes in this scenario. |
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| Keywords: | Intensive care unit Burns Outcomes assessment Health status indicators Fluid balance |
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