Dembinski Rolf, Kauczok Jens, Deisz Robert, Pallua Norbert, Marx Gernot
Universitätsklinikum der RWTH Aachen.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2012 Sep;47(9):542-53; quiz 554. doi: 10.1055/s-0032-1325285. Epub 2012 Sep 11.
Critical care medicine in severely burned patients should be adapted to the different pathophysiological phases. Accordingly, surgical and non-surgical therapy must be coordinated adequately. Initial wound care comprises topical treatment of less severely injured skin and surgical debridement of severely burned areas. The first 24 hours of intensive care are focused on calculated fluid delivery to provide stable hemodynamics and avoid progression of local edema formation. In the further course wound treatment with split-thickness skin grafts is the major aim of surgical therapy. Critical care is focused on the avoidance of complications like infections and ventilator associated lung injury. Therefore, lung-protective ventilation strategies, weaning and sedation protocols, and early enteral nutrition are important cornerstones of the treatment.
严重烧伤患者的重症监护医学应适应不同的病理生理阶段。因此，手术治疗和非手术治疗必须充分协调。初始伤口护理包括对轻度受伤皮肤的局部治疗和对严重烧伤区域的手术清创。重症监护的最初24小时重点是精确的液体输注，以提供稳定的血流动力学并避免局部水肿加重。在后续过程中，采用中厚皮片进行伤口治疗是手术治疗的主要目标。重症监护的重点是避免感染和呼吸机相关性肺损伤等并发症。因此，肺保护性通气策略、撤机和镇静方案以及早期肠内营养是治疗的重要基石。
