Burns injury - PACT - ESICM
Burns injury - PACT - ESICM
Burns injury - PACT - ESICM
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Pruitt BA Jr. The diagnosis and treatment of infection in the burn patient.<br />
<strong>Burns</strong> Incl Therm Inj 1984; 11(2); 79–91. PMID 6525539<br />
Greenhalgh DG, Saffle JR, Holmes JH 4th, Gamelli RL, Palmieri TL, Horton JW,<br />
et al. American Burn Association consensus conference to define sepsis<br />
and infection in burns. J Burn Care Res 2007; 28(6): 776–790. PMID<br />
17925660<br />
Chipp E, Milner CS, Blackburn AV. Sepsis in burns: a review of current practice<br />
and future therapies. Ann Plast Surg 2010; 65(2): 228–236. PMID<br />
20606586<br />
Ravat F, Le-Floch R, Vinsonneau C, Ainaud P, Bertin-Maghit M, Carsin H, et al,<br />
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Metabolic alterations and nutrition<br />
The metabolic response to major burns (>20% TBSA) is characterised by an initial<br />
‘ebb phase’ followed within 24 to 48 hrs by the 'flow phase', i.e. to a hypermetabolic<br />
response.<br />
The metabolic disturbances are qualitatively similar to those of other<br />
critically ill patients (hypermetabolism, increased gluconeogenesis, insulin<br />
resistance, increase in endogenous lipolysis and net loss of the lean body mass) but<br />
are much more intensive and persistent (weeks to months).<br />
The cytokine and mediator release is characterised by the intensity and the<br />
prolonged persistence of the oxidative stress. This response is due to the time<br />
required for burn wounds to heal with the response abating after closure of the<br />
wounds. The increases in stress hormones (catecholamines) are particularly marked.<br />
The body’s response includes an elevation in body temperature, cardiac output and<br />
substrate turnover rate, causing an important increase in energy demand. The<br />
elevation in energy expenditure (EE), is directly related to several factors including<br />
the extent of the burn <strong>injury</strong>, time elapsed since <strong>injury</strong> and the presence of septic<br />
complications. There is an important variation over time in the EE which is difficult<br />
to predict, rendering indirect calorimetric measurements particularly valuable.<br />
Current burn <strong>injury</strong> treatments appear to have attenuated the hypermetabolic<br />
response compared to data from the 1980s. The peak of hypermetabolism lasts from<br />
5 to 21 days after <strong>injury</strong>, and declines progressively thereafter.<br />
Cunningham JJ. Factors contributing to increased energy expenditure in<br />
thermal <strong>injury</strong>: a review of studies employing indirect calorimetry. JPEN<br />
J Parenter Enteral Nutr 1990; 14(6): 649–656. PMID 2273535<br />
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