Cardiac and pulmonary complications in burned patients

Abstract

Across the world, the majority of burn deaths (90%) occur in lower middle or low income countries. Slightly more than 7% occur in high middle-income countries. Only 3% of burn deaths occur in High Income Countries (HIC). The rate of child injury death from fire and flames is nearly 11 times higher in LIC than in HIC. Burns are unique among acute injuries in the progressive nature of tissue necrosis and possible serious complications following the initial trauma, such as systemic inflammatory response syndrome (SIRS) and severe metabolic imbalance. This intense instability in homeostasis may result in multiple organ failure and death. Hemodynamic features of burn shock comprise a decrease in Cardiac output (in the order of 40-60%), stroke volume, venous return, Coronary blood flow, Peak systolic blood pressure, Mean arterial pressure, Estimated myocardial work, Stroke work, Myocardial oxygenation (ischemia), Myocardial contractility and Myocardial compliance. Perfusion of many body tissues is thus much more impaired in non-survivors compared to survivors, as evidenced by a higher lactic acid level. Patients who sustain burn injury will suffer pulmonary complications in 16% to 41% of hospitalized cases. The severity of associated inhalation injury is one of the most important determinants of mortality in patients with thermal injury.