Prognosis and Management of Severe Burns

Mortality Risk Factors

• Age, total body surface area (TBSA) burned, and presence of smoke inhalation are the main risk factors affecting mortality in severe burns, according to the American Society of Anesthesiologists 1
• The presence of inhalation injury significantly worsens prognosis and increases mortality risk, as reported by the American Society of Anesthesiologists 1, 2

Expected Complications

Respiratory Complications

• Patients with facial burns and inhalation injury should be closely monitored for glottis edema and respiratory distress, as recommended by the American Society of Anesthesiologists 2
• Intubation should be considered if the patient has very extensive burns (TBSA >40%) along with deep circular neck burns or symptoms of airway obstruction, according to the American Society of Anesthesiologists 2

Cardiovascular Complications

• Hypovolemic shock is common and requires aggressive fluid resuscitation, as stated by the American Society of Anesthesiologists 3

Management Priorities to Improve Prognosis

Specialized Care

• Patients with >20% TBSA burns in adults should be referred to a specialized burn center immediately, as recommended by the American Burn Association 1, 4
• Direct admission to a burn center is associated with better survival and decreased morbidity, according to the American Burn Association 5
• Telemedicine consultation with burn specialists should be utilized if immediate transfer is not possible, as suggested by the American Burn Association 1

Fluid Resuscitation

• Proper fluid resuscitation is critical in the first 24-48 hours, as emphasized by the American Society of Anesthesiologists 3
• Balanced crystalloid solutions are recommended for initial fluid resuscitation, according to the American Society of Anesthesiologists 3

Infection Prevention

• Systemic antibiotic prophylaxis in the first 4-14 days has been shown to reduce mortality by nearly half in burn patients, as reported by the World Society of Emergency Surgery 6

Exclusion Criteria for ICU Admission During Mass Casualty Events

• According to triage protocols, patients with severe burns meeting specific criteria may be excluded from ICU admission during mass casualty events, as stated by the European Society of Intensive Care Medicine 7
• These criteria include burns with >40% TBSA affected in patients >60 years of age, or burns with inhalation injury, as reported by the European Society of Intensive Care Medicine 7

Long-term Considerations

• Early surgical excision and skin grafting significantly reduce morbidity, mortality, and length of hospital stay, as reported by the American Society of Anesthesiologists 5
• Survivors of extensive burns face significant functional limitations and may require prolonged rehabilitation, according to the American Burn Association 4