Yanık
Özet
Yanık yaralanmaları, yoğun bakım ünitesinde özel bakım ve takip gerektiren tüm dünyada ciddi morbidite ve mortalite nedeni olan yaralanmalardır. Yanıklı hasta bakımının ilk aşaması değerlendirme ve resüsitasyona dayalıdır. Yanık boyutu ve ciddiyetinin doğru sınıflandırılması akabinde hastaya solunum ve dolaşım resüsitasyonu yapılması çok önemlidir. Bununla birlikte uygun analjezinin erkenden başlatılması, inhalasyon hasarının yönetimi, hipermetabolik yanıta bağlı özel nutrisyon desteği hasta takibi boyunca gözden kaçırılmamalıdır. Yanık yarası takibi ve yara yerlerinde oluşabilecek enfeksiyonlar açısından dikkatli olunmalı, yoğun bakım takipleri boyunca hastalara psikolojik destek verilmesi gerekliliği de unutulmamalıdır. Sonuç olarak, yoğun bakım ünitesinde yanık hastası yönetimi oldukça titiz, multidisipliner bir yaklaşım gerektirmektedir.
Burn injuries requires special care and follow-up in the intensive care unit and are serious cause of morbidity and mortality all over the world. The first phase of burn patient care is based on assessment and resuscitation. It is very important to provide respiratory and circulatory resuscitation to the patient after correctly classifying the size and severity of burn injury. However, early initiation of appropriate analgesia, management of inhalation injury and special nutritional support due to hypermetabolic response should not be overlooked during patient follow-up. Care should be taken in terms of burn wound monitoring and infections that may occur in wound areas and should not be forgotten that patients should be given psychological support during intensive care follow-ups. In conclusion, burn patient management in the intensive care unit requires a very meticulous, multidisciplinary approach.
Referanslar
American Burn Association. National Burn Repository 2019 Update, Report of data from 2009–2018 ameriburn.site-ym.com https://ameriburn.site-ym.com/store/ViewProduct.aspx?id=14191872 (2019).
Nguyen, C. M., Chandler, R., Ratanshi, I. & Logsetty, S. in Handbook of Burns Vol. 1 (eds. Jeschke, M. G., Kamolz, L.-P., Sjöberg, F. & Wolf, S. E.) 529–547 (Springer, 2020).
Jeschke, M.G., van Baar, M.E., Choudhry, M.A. et al. Burn injury. Nat Rev Dis Primers 6, 11 (2020). https://doi.org/10.1038/s41572-020-0145-5
Pruitt BA Jr, Wolf SE, Mason AD Jr. Atlas of burn care. Elsevier Health Sciences, 2016.
Jeschke MG. Handbook of burns volume 1: Acute burn care. Springer, 2012.
American Burn Association. Guidelines for burn care. https://ameriburn.org/public-resources/guidelines/. Erişim tarihi: 20 Haziran 2023.
Otterness K, Ahn C. Emergency department management of smoke inhalation injury in adults. Emerg Med Pract. 2018 Mar;20(3):1-24. Epub 2018 Mar 1. PMID: 29489306.
Tan A, Smailes S, Friebel T, Magdum A, Frew Q, El-Muttardi N, Dziewulski P. Smoke inhalation increases intensive care requirements and morbidity in paediatric burns. Burns. 2016 Aug;42(5):1111-1115. doi: 10.1016/j.burns.2016.02.010. Epub 2016 Jun 6. PMID: 27283733.
Dries DJ, Endorf FW. Inhalation injury: epidemiology, pathology, treatment strategies. Scand J Trauma Resusc Emerg Med. 2013 Apr 19;21:31. doi: 10.1186/1757-7241-21-31. PMID: 23597126; PMCID: PMC3653783.
Silva L, Garcia L, Oliveira B, Tanita M, Festti J, Cardoso L, Lavado L, Grion C. Acute respiratory distress syndrome in burn patients: incidence and risk factor analysis. Ann Burns Fire Disasters. 2016 Sep 30;29(3):178-182. PMID: 28149245; PMCID: PMC5266233.
Madnani DD, Steele NP, de Vries E. Factors that predict the need for intubation in patients with smoke inhalation injury. Ear Nose Throat J. 2006 Apr;85(4):278-80. PMID: 16696366.
Gill, P., & Martin, R. V. (2015). Smoke inhalation injury. BJA Education, 15(3), 143-148.
FW, Xin HM, Zhu JH, Feng XY, Jiang XC, Gong ZY, Tong YL. [Treatment of patients with different degree of acute respiratory distress syndrome caused by inhalation of white smoke]. Zhonghua Shao Shang Za Zhi. 2017 Dec 20;33(12):760-765. Chinese. doi: 10.3760/cma.j.issn.1009-2587.2017.12.008. PMID: 29275617.
29. Elsharnouby NM, Eid HE, Abou Elezz NF, Aboelatta YA. Heparin/N-acetylcysteine:an adjuvant in the management of burn inhalation injury:a study of different doses. J Crit Care. 2014;29:182, e1–4.
Greenhalgh DG, Warner P. Potential studies in extubation adjuncts after inhalation injury. J Burn Care Res. 2009;30:199–200
Boldt J, Papsdorf M. Fluid management in burn patients: results from a European survey-more questions than answers. Burns. 2008 May;34(3):328-38. doi: 10.1016/j.burns.2007.09.005. Epub 2008 Jan 16. PMID: 18201828.
Baxter CR. Fluid volume and electrolyte changes of the early postburn period. Clin Plast Surg. 1974 Oct;1(4):693-703.
Kagan RJ, Peck MD, Ahrenholz DH, Hickerson WL, Holmes J 4th, Korentager R, Kraatz J, Pollock K, Kotoski G. Surgical management of the burn wound and use of skin substitutes: an expert panel white paper. J Burn Care Res. 2013 Mar-Apr;34(2):e60-79. doi: 10.1097/BCR.0b013e31827039a6. PMID: 23446645.
Rafla K, Tredget EE. Infection control in the burn unit. Burns. 2011 Feb;37(1):5-15. doi: 10.1016/j.burns.2009.06.198. Epub 2010 Jun 18. PMID: 20561750.
Carrougher GJ, Ptacek JT, Sharar SR et al. Comparison of patient satisfaction and self-reports of pain in adult burn-injured patients. J Burn Care
Weinberg K, Birdsall C, Vail D, Marano MA, Petrone SJ, Mansour EH. Pain and anxiety with burn dressing changes: patient self-report. J Burn Care Rehabil 2000;21(2):155–6; discussion 157
Foertsch CE, O’Hara MW, Kealey GP, Foster LD, Schumacher EA. A quasi-experimental, dual-center study of morphine efficacy in patients with burns. J Burn Care Rehabil 1995;16(2 Pt 1):118–126
Romanowski KS, Carson J, Pape K, Bernal E, Sharar S, Wiechman S, Carter D, Liu YM, Nitzschke S, Bhalla P, Litt J, Przkora R, Friedman B, Popiak S, Jeng J, Ryan CM, Joe V. American Burn Association Guidelines on the Management of Acute Pain in the Adult Burn Patient: A Review of the Literature, a Compilation of Expert Opinion, and Next Steps. J Burn Care Res. 2020 Nov 30;41(6):1129-1151. doi: 10.1093/jbcr/iraa119. PMID: 32885244; PMCID: PMC7703676.
Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med 2011;365(6):506–17.
Chen Z, Wang S, Yu B, et al. A comparison study between early enteral nutrition and parenteral nutrition in severe burn patients. Burns 2007;33(6):708–12.
Rollins C, Huettner F, Neumeister MW. Clinician's Guide to Nutritional Therapy Following Major Burn Injury. Clin Plast Surg. 2017 Jul;44(3):555-566. doi: 10.1016/j.cps.2017.02.014. PMID: 28576244.
Pham TN, Klein MB, Gibran NS, et al. Impact of oxandrolone treatment on acute outcomes after severe burn injury. J Burn Care Res 2008;29(6):902–6.
van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345(19):1359–67.
Hart DW, Wolf SE, Chinkes DL, et al. Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after severe burn. J Trauma 2003;54(4):755–61 [discussion: 761–4].
Referanslar
American Burn Association. National Burn Repository 2019 Update, Report of data from 2009–2018 ameriburn.site-ym.com https://ameriburn.site-ym.com/store/ViewProduct.aspx?id=14191872 (2019).
Nguyen, C. M., Chandler, R., Ratanshi, I. & Logsetty, S. in Handbook of Burns Vol. 1 (eds. Jeschke, M. G., Kamolz, L.-P., Sjöberg, F. & Wolf, S. E.) 529–547 (Springer, 2020).
Jeschke, M.G., van Baar, M.E., Choudhry, M.A. et al. Burn injury. Nat Rev Dis Primers 6, 11 (2020). https://doi.org/10.1038/s41572-020-0145-5
Pruitt BA Jr, Wolf SE, Mason AD Jr. Atlas of burn care. Elsevier Health Sciences, 2016.
Jeschke MG. Handbook of burns volume 1: Acute burn care. Springer, 2012.
American Burn Association. Guidelines for burn care. https://ameriburn.org/public-resources/guidelines/. Erişim tarihi: 20 Haziran 2023.
Otterness K, Ahn C. Emergency department management of smoke inhalation injury in adults. Emerg Med Pract. 2018 Mar;20(3):1-24. Epub 2018 Mar 1. PMID: 29489306.
Tan A, Smailes S, Friebel T, Magdum A, Frew Q, El-Muttardi N, Dziewulski P. Smoke inhalation increases intensive care requirements and morbidity in paediatric burns. Burns. 2016 Aug;42(5):1111-1115. doi: 10.1016/j.burns.2016.02.010. Epub 2016 Jun 6. PMID: 27283733.
Dries DJ, Endorf FW. Inhalation injury: epidemiology, pathology, treatment strategies. Scand J Trauma Resusc Emerg Med. 2013 Apr 19;21:31. doi: 10.1186/1757-7241-21-31. PMID: 23597126; PMCID: PMC3653783.
Silva L, Garcia L, Oliveira B, Tanita M, Festti J, Cardoso L, Lavado L, Grion C. Acute respiratory distress syndrome in burn patients: incidence and risk factor analysis. Ann Burns Fire Disasters. 2016 Sep 30;29(3):178-182. PMID: 28149245; PMCID: PMC5266233.
Madnani DD, Steele NP, de Vries E. Factors that predict the need for intubation in patients with smoke inhalation injury. Ear Nose Throat J. 2006 Apr;85(4):278-80. PMID: 16696366.
Gill, P., & Martin, R. V. (2015). Smoke inhalation injury. BJA Education, 15(3), 143-148.
FW, Xin HM, Zhu JH, Feng XY, Jiang XC, Gong ZY, Tong YL. [Treatment of patients with different degree of acute respiratory distress syndrome caused by inhalation of white smoke]. Zhonghua Shao Shang Za Zhi. 2017 Dec 20;33(12):760-765. Chinese. doi: 10.3760/cma.j.issn.1009-2587.2017.12.008. PMID: 29275617.
29. Elsharnouby NM, Eid HE, Abou Elezz NF, Aboelatta YA. Heparin/N-acetylcysteine:an adjuvant in the management of burn inhalation injury:a study of different doses. J Crit Care. 2014;29:182, e1–4.
Greenhalgh DG, Warner P. Potential studies in extubation adjuncts after inhalation injury. J Burn Care Res. 2009;30:199–200
Boldt J, Papsdorf M. Fluid management in burn patients: results from a European survey-more questions than answers. Burns. 2008 May;34(3):328-38. doi: 10.1016/j.burns.2007.09.005. Epub 2008 Jan 16. PMID: 18201828.
Baxter CR. Fluid volume and electrolyte changes of the early postburn period. Clin Plast Surg. 1974 Oct;1(4):693-703.
Kagan RJ, Peck MD, Ahrenholz DH, Hickerson WL, Holmes J 4th, Korentager R, Kraatz J, Pollock K, Kotoski G. Surgical management of the burn wound and use of skin substitutes: an expert panel white paper. J Burn Care Res. 2013 Mar-Apr;34(2):e60-79. doi: 10.1097/BCR.0b013e31827039a6. PMID: 23446645.
Rafla K, Tredget EE. Infection control in the burn unit. Burns. 2011 Feb;37(1):5-15. doi: 10.1016/j.burns.2009.06.198. Epub 2010 Jun 18. PMID: 20561750.
Carrougher GJ, Ptacek JT, Sharar SR et al. Comparison of patient satisfaction and self-reports of pain in adult burn-injured patients. J Burn Care
Weinberg K, Birdsall C, Vail D, Marano MA, Petrone SJ, Mansour EH. Pain and anxiety with burn dressing changes: patient self-report. J Burn Care Rehabil 2000;21(2):155–6; discussion 157
Foertsch CE, O’Hara MW, Kealey GP, Foster LD, Schumacher EA. A quasi-experimental, dual-center study of morphine efficacy in patients with burns. J Burn Care Rehabil 1995;16(2 Pt 1):118–126
Romanowski KS, Carson J, Pape K, Bernal E, Sharar S, Wiechman S, Carter D, Liu YM, Nitzschke S, Bhalla P, Litt J, Przkora R, Friedman B, Popiak S, Jeng J, Ryan CM, Joe V. American Burn Association Guidelines on the Management of Acute Pain in the Adult Burn Patient: A Review of the Literature, a Compilation of Expert Opinion, and Next Steps. J Burn Care Res. 2020 Nov 30;41(6):1129-1151. doi: 10.1093/jbcr/iraa119. PMID: 32885244; PMCID: PMC7703676.
Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med 2011;365(6):506–17.
Chen Z, Wang S, Yu B, et al. A comparison study between early enteral nutrition and parenteral nutrition in severe burn patients. Burns 2007;33(6):708–12.
Rollins C, Huettner F, Neumeister MW. Clinician's Guide to Nutritional Therapy Following Major Burn Injury. Clin Plast Surg. 2017 Jul;44(3):555-566. doi: 10.1016/j.cps.2017.02.014. PMID: 28576244.
Pham TN, Klein MB, Gibran NS, et al. Impact of oxandrolone treatment on acute outcomes after severe burn injury. J Burn Care Res 2008;29(6):902–6.
van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345(19):1359–67.
Hart DW, Wolf SE, Chinkes DL, et al. Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after severe burn. J Trauma 2003;54(4):755–61 [discussion: 761–4].
