6 Critical Care of Burn Victims Including Inhalation Injury

77

< 3.0

Cardiac Index

> 3.0

ITBI

ITBI

< 850

> 850

< 850

> 850

ELWI

ELWI

ELWI

ELWI

< 10

> 10

< 10

> 10

< 10

> 10

< 10

> 10

↑ Volume

↑ Volume

↑ Catechol

↑ Volume ↑ Volume

OK

↓ Volume

↑ Catechol

↑ Catechol ↓ Volume

Fig. 6.1 Treatment algorithm to maintain adequate organ perfusion using inotropes, ßuid, CI and diuretics (From [11])

a marker of pulmonary edema. The use of TPTD goal-directed therapy based on ITBV and EVLW measurements in critically ill patients has been studied in various prospective trials and showed promising results, none of these is, however, speciÞc for burn patients.

In our center, we use an algorithm to optimize ßuid resuscitation and cardiac performance in the acute setting as well as during the ICU stay [11] (Fig. 6.1):

6.2.7Serum Organ Markers

In our opinion, it is imperative to follow organ function from the initial phase after injury throughout ICU and hospital stay. The most feasible approach is to measure serum markers of organ function or dysfunction/damage. We recommend [4]:

¥Cardiac markers: troponin, A- and B-natriuretic peptide, CK

¥Liver: AST, ALT, Bili, ALKP

¥Pancreas: amylase, lipase

¥Kidney: BUN, creatinine

¥Hematology: CBC including coagulation, differential including bands

¥Hormonal: cortisol including ACTH challenge, thyroid axis, GnRH

For longitudinal observation, it is recommended to obtain admission values and

measures values once or twice per week.

6.3Later Hospital Phase

The later phase includes critical practices to maintain organ function, control infection and sepsis, and alleviate hypermetabolism. This section will focus on maintaining organ function and complication of long-term ICU sequelae as infection and sepsis are discussed in detail in Chap. 5, and hypermetabolism is covered in Chap. 8.