Current Approaches to Intensive Care of Acute Toxemia in Severely Burned Adults

Abstract

ABSTRACT OBJECTIVES: Numerous studies have shown that the pathogenesis of burn toxemia based on the resorption of tissue necrosis products from burned tissue into the blood and lymph. Debridement of necrotic tissue of the burned area is reported to result in a decrease of body temperature in 1 to 2 days. The aim of the study was to evaluate features of the toxemia period in the intensive care unit patients to find out effectiveness of the comprehensive intensive therapy in first days of burn injury. MATERIALS AND METHODS: The intensive care unit data of 8 patients with severe thermal burns were analyzed retrospectively, including the vital signs, duration of the intensive care unit, daily fluid volume, blood glucose levels, utilized medication, and nutritional support. Statistical analysis was performed using Microsoft Excel and t test. RESULTS: The duration of stay in the intensive care unit was 13 ± 2.3 days with a total of 25.8 ± 8.9 days of hospitalization. The burned areas were 51.4 ± 19.7% in grade II-IIIA patients, 11.8 ± 8.9% in grade IIIB patients, and by Frank index of 92.5 ± 20.8. There was a correlation between the fluid therapy and systolic blood pressure. The volume of infusion therapy, albumin, parenteral nutritional supplementation, and blood glucose levels were correlated with decreased toxemia symptoms. Administration of antibiotics and heparin was not associated with the toxemia. Dopamine administration was maximal on the day 2 and was associated with patients’ hemodynamic situation. CONCLUSIONS: The inflammation was decreased with the parenteral glucose and nutritional supplements and anesthetics. The reverse correlation between the antibiotic therapy and toxemia indicated the correction of hemodynamic failure leading to a decrease of toxemia. The physical data and patients’ complaints were not objective indicators of intensive care effectiveness.