Department of Trauma and Burn Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands; Department of Anesthesiology, Amsterdam UMC, Location VU Medical Center, Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
Association of Dutch Burn Centers, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Burns. 2019 Aug;45(5):1057-1065. doi: 10.1016/j.burns.2019.02.005. Epub 2019 Mar 2.
Mortality in burn intensive care unit (ICU) has been decreasing and treatment appears to be changing. The aims of this study: (1) examine outcome in burn patients, (2) examine changes in ICU indication and (3) explore the influence of a changing case-mix.
Retrospective study in patients admitted to ICU (1987-2016). Four groups were specified: major burns (≥15% TBSA), inhalation injury with small injury (<15% TBSA, inhalation injury), watchful waiting (<15% TBSA, without inhalation injury), tender loving care (patients withheld from treatment). Logistic regression was performed to evaluate the relation between case-mix and outcome.
Overall mortality decreased to 7%. Mortality of major burns decreased by 15%. The major burn group decreased by 36%. The inhalation injury and watchful waiting group increased by 9% and 21%. The percentage of ventilated patients increased by 14% in the major burn group. 40% of patients were ventilated in the watchful waiting group.
After correction for case-mix, survival improved, mainly in the major burn group. Case-mix shifted towards inhalation injury and watchful waiting. Growth of the watchful waiting group is not necessarily harmful. However, the increase of mechanical ventilation could be. We suggest raising awareness for risks and consequences of mechanical ventilation.
烧伤重症监护病房（ICU）的死亡率一直在下降，治疗方法似乎也在发生变化。本研究的目的是：（1）检查烧伤患者的预后；（2）检查 ICU 适应证的变化；（3）探讨病例组合变化的影响。
对 ICU 收治的患者进行回顾性研究（1987-2016 年）。指定了四个组：大面积烧伤（≥15% TBSA）、小面积烧伤伴吸入性损伤（<15% TBSA，吸入性损伤）、观察等待（<15% TBSA，无吸入性损伤）、精心护理（未接受治疗的患者）。采用逻辑回归评估病例组合与结局之间的关系。
总体死亡率下降至 7%。大面积烧伤患者的死亡率下降了 15%。大面积烧伤组下降了 36%。吸入性损伤和观察等待组分别增加了 9%和 21%。大面积烧伤组需要机械通气的患者比例增加了 14%。在观察等待组，有 40%的患者需要机械通气。
在对病例组合进行校正后，存活率有所提高，主要是在大面积烧伤组。病例组合向吸入性损伤和观察等待组转移。观察等待组的增长不一定有害。然而，机械通气的增加可能是有害的。我们建议提高对机械通气的风险和后果的认识。
