Burn Patient Management in Intensive Care

Initial Evaluation and Severity Criteria

The American Burn Association recommends using the Lund-Browder method to measure the total body surface area (TBSA) burned, as it is the most accurate and appropriate for both adults and children 1, 3
The rule of nines by Wallace overestimates the TBSA and is not suitable for children 1
As a practical alternative in prehospital settings, the patient's open palm (palm and fingers) can be used to estimate 1% of the TBSA 1
Criteria for severe burns in adults requiring ICU admission include TBSA burned >20% 3, deep burns >5% 1, smoke inhalation 5, deep burns in functional areas (face, hands, feet, perineum) 3, and high-voltage electrical burns 3
Additional criteria for TBSA <20% include age >75 years with severe comorbidities 3, circular deep burns 6, and TBSA >10% with deep burns 3-5% 4

The American College of Surgeons recommends administering 2-4 mL/kg/%TBSA of balanced crystalloid solution (preferably Ringer's lactate) in the first 24 hours, with half of the volume given in the first 8 hours 1, 2
The Parkland formula should be used to calculate the 24-hour fluid requirements 2, 4
The goal of urine output is 0.5-1 mL/kg/hour in adults, and fluid administration should be adjusted according to clinical response 2, 4
Children require higher volumes (approximately 6 mL/kg/%TBSA) due to their higher surface-to-weight ratio 2, 4
Formal resuscitation should be initiated in children with TBSA ≥5% 4

The European Burn Association recommends starting human albumin 5% between 8-12 hours post-burn in patients with severe burns (TBSA >30%) to reduce crystalloid administration and prevent fluid creep 7, 2
The protocol for administration includes maintaining serum albumin levels >30 g/L with doses of 1-2 g/kg/day 2, 4
Albumin reduces the volume of crystalloids needed and decreases complications related to fluid overload, including acute respiratory distress syndrome, acute kidney injury, and abdominal compartment syndrome 7, 2

The American Society of Anesthesiologists recommends not routinely intubating patients with facial or cervical burns 7, 6, 5
Specific criteria for intubation in complete facial burns include deep and circular neck burns, symptoms of airway obstruction, and extensive burns (TBSA ≥40%) 6, 5
Unnecessary intubation in the prehospital setting occurs in almost one-third of patients and is associated with more complications 6, 5
Patients with facial/cervical burns exposed to vapors or smoke inhalation should be closely monitored for risk of glottic edema 6, 5

The Society of Critical Care Medicine recommends monitoring for compartment syndrome, especially in circular third-degree burns that can cause acute limb or torso compartment syndrome 2, 4
Escarotomy should be performed when deep circular burns cause constriction and increased compartment pressure, ideally in a burn center 1, 2, 4
If transfer is not feasible, specialized advice should be obtained before performing the procedure 1
Lesion renal aguda should be monitored, and if hypotension persists despite adequate resuscitation, cardiac function should be evaluated with echocardiography, and vasopressors should be considered 2, 4

The American Burn Association recommends not underestimating fluid requirements in electrical burns, which can cause deeper tissue damage than apparent on the surface 2
Escarotomy should not be delayed when indicated, as timely performance is associated with reduced morbidity 2
The Parkland formula should not be used rigidly without adjusting according to clinical response, as 37.5% of ICUs do not follow it exactly 2
Administration of colloids (albumin) should not be omitted after the first 6-12 hours in severe burns, as it can prevent complications from crystalloid overload 7, 2