Die Therapie des Verbrennungsschocks – die ersten 24 h und darüber hinaus

 

 Buy Article Permissions and Reprints

Zusammenfassung

Die Therapie des Verbrennungsschocks weist im Unterschied zu anderen Schockformen einige Besonderheiten auf, welche selbst spezialisierte Zentren immer wieder vor Herausforderungen stellen. Die S2k-Leitlinie der Deutschen Gesellschaft für Verbrennungsmedizin (DGV) gibt hierzu therapeutische Handlungsempfehlungen auf dem Boden der verfügbaren Evidenz. Das folgende Positionspapier möchte Hinweise zum praktischen Vorgehen einschließlich eines Therapiealgorithmus ergänzen, die sowohl innerhalb spezialisierter Verbrennungszentren als auch in erstversorgenden Kliniken umgesetzt werden können. Diese sind als Good-Practice-Points (GPP) zu verstehen und stellen die Position des Arbeitskreises Intensivmedizin im Sinne eines Expertenkonsensus dar. Die Kurzversion des Positionspapieres ist abrufbar über: https://verbrennungsmedizin.de/files/dgv_files/pdf/positionspapier/Pos%20Therapie%20des%20Verbrennungsschock%20AK%20Intensivmedizin%202023.pdf

Abstract

Acute phase and resuscitation after burn trauma are challenging even for specialised burn centres due to the individual onset and differences compared with other forms of shock. The guidelines of the German Society of Burn Medicine (DGV) cover the scientific basis of modern burn treatment. Nevertheless, uncertainty remains regarding the detailed practical handling. This expert consensus focuses on best practices for the treatment of patients with major burns in specialised burn centres and by clinical first responders. The short version of this expert consensus can be downloaded at: https://verbrennungsmedizin.de/files/dgv_files/pdf/positionspapier/Pos%20Therapie%20des%20Verbrennungsschock%20AK%20Intensivmedizin%202023.pdf

Publication History

Received: 29 September 2023

Accepted: 29 October 2023

Article published online:
27 February 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Baxter CR, Cook WA, Shires GT. Serum myocardial depressant factor of burn shock. Surg Forum 1966; 17: 1-2
  PubMedGoogle Scholar
• 2 Wurzer P. et al. Pathophysiology of burn shock and burn edema, in Total burn care. 2018. Elsevier; 66-76. e3
  Google Scholar
• 3 Arlati S. et al. Decreased fluid volume to reduce organ damage: a new approach to burn shock resuscitation? A preliminary study. Resuscitation 2007; 72: 371-378
  CrossrefPubMedGoogle Scholar
• 4 Cancio LC. et al Predicting increased fluid requirements during the resuscitation of thermally injured patients. J Trauma 2004; 56: 404-413 discussion 413-4.
  CrossrefPubMedGoogle Scholar
• 5 Ete G. et al. Effectiveness of Parkland formula in the estimation of resuscitation fluid volume in adult thermal burns. Chin J Traumatol 2019; 22: 113-116
  CrossrefPubMedGoogle Scholar
• 6 Greenhalgh DG. Burn resuscitation: the results of the ISBI/ABA survey. Burns 2010; 36: 176-182
  CrossrefPubMedGoogle Scholar
• 7 Marx G. et al S3-Leitlinie Intravasale Volumentherapie beim Erwachsenen. Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin AWMF-Register. 2014 001/020
  PubMedGoogle Scholar
• 8 Zander R. Anforderungen an einen optimalen Volumenersatz. Anästh Intensivmed 2009; 50: 348-357
  PubMedGoogle Scholar
• 9 Gille J. et al. Safety of resuscitation with Ringer’s acetate solution in severe burn (VolTRAB) – an observational trial. Burns 2014; 40: 871-880
  CrossrefPubMedGoogle Scholar
• 10 Committee IPG, Steering S, Advisory S. ISBI Practice Guidelines for Burn Care. Burns 2016; 42: 953-1021
  CrossrefPubMedGoogle Scholar
• 11 Leape IL. Kinetics of burn edema formation in primates. Ann Surg 1972; 176: 223-226
  CrossrefPubMedGoogle Scholar
• 12 Blanco-Schweizer P. et al. Resuscitation with albumin using BET formula keeps at bay fluid administration in burned patients. An observational study. Burns 2020; 46: 860-867
  CrossrefPubMedGoogle Scholar
• 13 Nielson CB. et al. Burns: Pathophysiology of Systemic Complications and Current Management. J Burn Care Res. 2017. 38. e469-e481
  Google Scholar
• 14 Vincent JL. et al. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care 2016; 20: 257
  CrossrefPubMedGoogle Scholar
• 15 Hofer CK. et al. Stroke volume and pulse pressure variation for prediction of fluid responsiveness in patients undergoing off-pump coronary artery bypass grafting. Chest 2005; 128: 848-854
  CrossrefPubMedGoogle Scholar
• 16 Boyd JH. et al. Echocardiography as a guide for fluid management. Crit Care 2016; 20: 274
  CrossrefPubMedGoogle Scholar
• 17 Zhang Z. et al. Ultrasonographic measurement of the respiratory variation in the inferior vena cava diameter is predictive of fluid responsiveness in critically ill patients: systematic review and meta-analysis. Ultrasound Med Biol 2014; 40: 845-853
  CrossrefPubMedGoogle Scholar
• 18 Beerthuizen G, Magnette A. European practice guidelines for burn care. Minimum level of burn care provision in Europe. Barcelona: European Burns Association; 2017
  Google Scholar
• 19 Rennekampff H-O. et al. Optimierung der chirurgischen Behandlung Brandverletzter: Auszüge aus der fachübergreifenden S2k-Leitlinie „Behandlung thermischer Verletzungen des Erwachsenen “. Handchirurgie· Mikrochirurgie· Plastische Chirurgie 2020; 52: 497-504
  Article in Thieme ConnectPubMedGoogle Scholar
• 20 Ivy ME. et al. Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma 2000; 49: 387-391
  CrossrefPubMedGoogle Scholar
• 21 Boehm D. et al. Fluid Management as a Risk Factor for Intra-abdominal Compartment Syndrome in Burn Patients: A Total Body Surface Area-Independent Multicenter Trial Part I. J Burn Care Res 2019; 40: 500-506
  CrossrefPubMedGoogle Scholar
• 22 Kirkpatrick AW. et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med 2013; 39: 1190-1206
  CrossrefPubMedGoogle Scholar