Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany.
Burn Center and Plastic Surgery, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683 Berlin, Germany.
Burns. 2019 Dec;45(8):1895-1900. doi: 10.1016/j.burns.2019.07.018. Epub 2019 Aug 2.
Burn trauma-related hypothermia is a frequent observation but risk factors and impact on patient related outcome are ambiguously reported. It is expected that hypothermia is associated with increased mortality and reduced overall outcome in severely burned patients, but available evidence is limited.
This retrospective single-center-study reviewed preclinical service protocols and medical records of patients sustaining a burn with a total body surface area (TBSA) ≥15% from 2008 to 2012. General patient and burn specific characteristics, outcome parameters as well as body temperature at admission measured via urine catheter or nasal temperature probe were recorded and statistically analyzed comparing normothermic (≥36 °C), mild hypothermic (<36 °C) and severely hypothermic (<34.5 °C) patients. Chi-square test was performed to demonstrate impact of hypothermia on primary outcome parameters and to reveal risk factors for developing hypothermia. To assess independent influences on mortality, a multivariate logistic regression analysis was performed.
Out of 300 patients matching inclusion criteria, a sufficient record of temperature was found in 144 patients (48%). Out of 141 eligible patients with an average burn extent (SD) of 33.38% (24.5%) TBSA, 31.9% (n = 45) suffered from severe hypothermia (<34.5 °C) and 28.4% (n = 40) showed mild hypothermia. Total burn extent, presence of full thickness burns, presence of inhalation injury, preclinical mechanical ventilation and administration of sedative drugs were risk factors for developing hypothermia. Patients' age, total burn extent and presence of full thickness burns could be identified as independent factor for mortality. Although a trend towards an independent positive influence of normothermia at admission on mortality was seen, it was not statistically significant.
Incidental hypothermia of burned patients is associated with an increased mortality and needs to be addressed by emergency health care providers and immediately at the burn center. Especially patients with extensive burns, full-thickness burns, inhalation injury or patients undergoing preclinical intubation are at risk for hypothermia and benefit from any measures for temperature preserving.
烧伤相关低体温是一种常见的观察结果，但风险因素及其对患者相关结局的影响报道并不明确。据推测，低体温与严重烧伤患者的死亡率增加和整体结局降低有关，但现有证据有限。
本回顾性单中心研究回顾了 2008 年至 2012 年期间全身表面积（TBSA）≥15%的烧伤患者的临床前服务方案和病历。记录了一般患者和烧伤特异性特征、结局参数以及通过导尿管或鼻温探头测量的入院时体温，并进行了统计学分析，比较了正常体温（≥36°C）、轻度低体温（<36°C）和严重低体温（<34.5°C）患者。卡方检验用于显示低体温对主要结局参数的影响，并揭示发生低体温的危险因素。为了评估对死亡率的独立影响，进行了多变量逻辑回归分析。
在符合纳入标准的 300 名患者中，有 144 名患者（48%）的体温记录充足。在 141 名符合条件的患者中，平均烧伤程度（SD）为 33.38%（24.5%）TBSA，31.9%（n=45）患有严重低体温（<34.5°C），28.4%（n=40）患有轻度低体温。总烧伤程度、全层烧伤、吸入性损伤、临床前机械通气和镇静药物的使用是发生低体温的危险因素。患者年龄、总烧伤程度和全层烧伤是死亡率的独立因素。尽管入院时正常体温对死亡率有独立的正向影响趋势，但无统计学意义。
烧伤患者的意外低体温与死亡率增加相关，需要由急救医疗服务提供者和烧伤中心立即处理。特别是那些烧伤面积大、全层烧伤、吸入性损伤或接受临床前插管的患者，存在低体温的风险，需要采取任何保持体温的措施。
