Mertin Viktoria, Most Patrick, Busch Martin, Trojan Stefan, Tapking Christian, Haug Valentin, Kneser Ulrich, Hundeshagen Gabriel
Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen am Rhein, Germany.
Division of Molecular and Translational Cardiology, Department of Internal Medicine III University Hospital Heidelberg, 69120 Heidelberg, Germany.
Burns Trauma. 2022 Sep 23;10:tkac031. doi: 10.1093/burnst/tkac031. eCollection 2022.
In this systematic review, we summarize the aetiology as well as the current knowledge regarding thermo(dys)regulation and hypothermia after severe burn trauma and aim to present key concepts of pathophysiology and treatment options. Severe burn injuries with >20% total body surface area (TBSA) affected commonly leave the patient requiring several surgical procedures, prolonged hospital stays and cause substantial changes to body composition and metabolism in the acute and long-term phase. Particularly in severely burned patients, the loss of intact skin and the dysregulation of peripheral and central thermoregulatory processes may lead to substantial complications.
A systematic and protocol-based search for suitable publications was conducted following the PRISMA guidelines. Articles were screened and included if deemed eligible. This encompasses animal-based studies as well as clinical studies examining the control-loops of thermoregulation and metabolic stability within burn patients.
Both experimental animal studies and clinical studies examining thermoregulation and metabolic functions within burn patients have produced a general understanding of core concepts which are, nonetheless, lacking in detail. We describe the wide range of pathophysiological alterations observed after severe burn trauma and highlight the association between thermoregulation and hypermetabolism as well as the interactions between nearly all organ systems. Lastly, the current clinical standards of mitigating the negative effects of thermodysregulation and hypothermia are summarized, as a comprehensive understanding and implementation of the key concepts is critical for patient survival and long-term well-being.
The available animal models have provided many insights into the interwoven pathophysiology of severe burn injury, especially concerning thermoregulation. We offer an outlook on concepts of altered central thermoregulation from non-burn research as potential areas of future research interest and aim to provide an overview of the clinical implications of temperature management in burn patients.
在本系统评价中，我们总结了严重烧伤创伤后热（调节）失调及体温过低的病因以及当前相关知识，旨在阐述病理生理学的关键概念和治疗选择。全身表面积（TBSA）超过20%的严重烧伤通常会使患者需要接受多次外科手术、延长住院时间，并在急性期和长期导致身体成分和代谢发生重大变化。特别是在严重烧伤患者中，完整皮肤的丧失以及外周和中枢体温调节过程的失调可能导致严重并发症。
按照PRISMA指南进行基于系统和方案的合适出版物检索。筛选并纳入被认为合格的文章。这包括基于动物的研究以及检查烧伤患者体温调节和代谢稳定性控制环路的临床研究。
对烧伤患者体温调节和代谢功能进行研究的实验动物研究和临床研究均对核心概念有了总体认识，但仍缺乏细节。我们描述了严重烧伤创伤后观察到的广泛病理生理改变，强调了体温调节与高代谢之间的关联以及几乎所有器官系统之间的相互作用。最后，总结了减轻体温调节失调和体温过低负面影响的当前临床标准，因为对关键概念的全面理解和实施对患者的生存和长期健康至关重要。
现有的动物模型为严重烧伤损伤相互交织的病理生理学，尤其是体温调节方面，提供了许多见解。我们对非烧伤研究中改变的中枢体温调节概念作为未来潜在研究兴趣领域进行了展望，旨在概述烧伤患者体温管理的临床意义。
