A retrospective review of two years of intensive care admissions with a primary diagnosis of burns in a quaternary burns centre

Dr Juliette Mewton1, Dr  John  Gowardman1

1Royal Brisbane and Women’s Hospital , Herston , Australia

Abstract:

Introduction. Ninety-one patients were admitted to the Intensive Care Unit during 2015-2017. Admission characteristics, primary treatment, analgesia management and antimicrobial screening, infections and treatment were reviewed.

Methods. A retrospective chart review of ninety-one patients admitted to the Intensive Care Unit with a primary diagnosis of Burns.

Results. Of ninety-one admissions sixty-four were male and twenty-seven female. Median age at presentation was forty-three years (range fifteen- eighty-five). Cause of burn was deliberate self-harm in twenty-six patients (28.5%), accidental causes sixty-four (70%) and one forensic (1.5%). The mechanism of burn was electrocution four patients, accelerant thirty-three, MVA 2, House fire/blast fourteen, camp fire eight, or other causes five patients. Twenty-eight (31%) were direct admissions, fifty-nine transitioned through one facility, four via two centres and four from overseas.
The Total Body Surface Area range was eight-ninety-eight percent. The ICU length of stay was a median twenty-two days (range one – seventy-six days). Ten were palliated within twenty-four hours of admission seventeen patients died during admission (18.68%). On presentation only fifty-three (58%) were normothermic. Fifty-one had a lacticaemia (maximum 10.2 mmol/l). Forty-one had a haemoglobin below eighty or above one hundred and fifty-five grams per litre. Sixty- seven (73.6%) had more fluid resuscitation than their parkland calculation and that was despite forty-one patients having no pre-ICU fluids recorded. Forty required vasopressors and three patients required multiple agents. During their Intensive care stay fifty-seven had positive sputum microscopy, twenty-three positive blood and/or urine and twenty positive donor sites. Twelve had positive MRO screens.

Conclusions. There is still significant clinical variation in management and review of primary resuscitation. Inter-hospital transfer and geography can complicate the primary resuscitation. Early debridement is essential. A review of microbiology and multiple resistant organism screening may reduce costs and streamline care.


Biography:

Currently working as a Fellow in the Royal Brisbane and Womens Hospital, having had a significant interest in Burns management during my training in the UK as a Surgeon and in Australia as an Intensivist.