Fenoldopam use in a burn intensive care unit: a retrospective study

Update on Severe Burn Management for the Intensivist

Thermal injury of humans causes arguably the most severe perturbations in physiology that can be experienced. These physiologic derangements start immediately and can persist in some form until months or even years after the burn wounds are healed. Burn shock, marked activation of the systemic inflammatory response, multiple-organ failure, infection, and wound failure are just a few of the insults that may require management by the intensivist. The purpose of this article is to review recent advances in the critical care management of thermally injured patients.

Association of rhabdomyolysis with renal outcomes and mortality in burn patients

The contribution of rhabdomyolysis to acute kidney injury (AKI) in the context of burn injury is poorly studied. We sought to determine the impact of rhabdomyolysis on AKI (defined by the AKI Network classification), renal replacement therapy (RRT), and death. Patients admitted to the burn unit at our institution were examined. Information on sex, age, presence of inhalation injury, electrical burn, percentage TBSA burned, percentage of full-thickness burns, Injury Severity Score, and peak creatine kinase (CK) were recorded. These variables were examined via multivariate logistic regression analysis against AKI Network stage, RRT, and death. Of 1973 consecutive admissions meeting the inclusion criteria, 525 met our eligibility criteria. Log peak CK was found to be correlated with any stage of AKI (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.36-2.16; P < .0001), moderate to severe AKI (OR, 2.09; 95% CI, 1.40-3.11; P = .0003), need for RRT (OR, 1.67; 95% CI, 1.16-2.40; P = .0057), and mortality (OR, 1.49; 95% CI, 1.01-2.20; P = .0441), after adjustment. Each 10-fold increase in peak CK was associated with a 70% increase in the odds of AKI, more than a 100% increase in the odds of moderate to severe AKI, a nearly 70% increase in the odds of RRT, and an almost 50% increase in the odds of mortality in patients with burn injury.