Healing dressings, high-calorie nutrition and physiotherapy from day one: this is how the ICUs work to save severely burned patients


Valencia was the protagonist of a nightmare this Thursday. About twenty fire crews, national and local police, military and health personnel mobilized to stop the flames of a fire that broke out at half past five in the afternoon in a residential building in the Campanar neighborhood. The fire destroyed two buildings – the one where it originated and another annex – forcing all residents to evacuate. At this time, there are 14 people missing and 10 dead. As for those hospitalized, there are five injured, four of them firefighters, with burns and poisoned by smoke. In a fire of this caliber, the burns caused can be very serious and endanger the life of the injured person. Here the Intensive Care Units (ICU) come into play, the cornerstone for the recovery of major burns. This is what is known as patients who have more than 20% of their body surface burned or suffer less extensive burns, but with an age or illness that requires abundant intravenous fluid administration. Higher degree burns are usually suffered from contact with fire, chemicals or electrocution. The days following admission are the most serious for the patient, and their survival also depends on the percentage of burned skin they present. Related News standard No The day after at ground zero of the fire in Valencia: “No one understands anything” Toni Jiménez standard No The official toll is four dead A young couple with a fifteen-day-old baby and a two-year-old child, among the missing Dounia Sbai “They need complicated and repeated care and treatment,” explains Dr. Manuel Sánchez, a specialist in severe burn injuries in the Intensive Medicine service at the La Paz University Hospital in Madrid. According to information from the Spanish Society of Intensive, Critical Medicine and Coronary Units (Semicyuc), their facilities take into account factors such as nutrition and early rehabilitation, with the aim of being able to provide rapid and complete patient care and improvement. Mechanical ventilation, intravenous hydration and sedoanalgesia Rehabilitation of a major burn requires multidisciplinary teams involving physiotherapists, psychologists, internists, surgeons… among other specialties. “The skin is just another organ and its loss has an impact on the entire body,” continues Sánchez, who details that the patient simultaneously needs treatments and techniques that protect several organs at the same time. For example, they use healing dressings, techniques to control fluid intake, dialysis, for possible infections, medication to maintain adequate blood pressure, mechanical ventilation or sedation analgesia. Higher degree burns are usually suffered by contact with fire, chemicals or electrocution. Danger of malnutrition in large burns. The doctor also emphasizes the importance of nutrition: «It is key to stopping the hypermetabolism caused by thermal trauma. If the loss of lean mass in a burn exceeds 10% of the total, there will be a delay in the healing of the burns, the grafted areas and their skin donor areas, which would lead to an increase in infections. In addition, the risk of suffering from pneumonia could increase, according to Dr. Marta Ugalde, an intensivist at the Cruces University Hospital. The caloric needs of severely burned patients are greater compared to the rest of the pathologies, which is why they need a high-calorie and high-protein diet, supplemented with glutamine and antioxidant vitamins. «If early nutritional therapy is applied, the stress response and ICU stay are reduced. If given orally, it maintains the trophism of the intestinal mucosa and increases the production of immunoglobulins in the intestine, which helps avoid ulcers and the risk of sepsis,” continues Dr. Ugalde. “The high-calorie diet helps prevent the appearance of ulcers or suffering from sepsis” Marta Ugalde Intensivist at the Cruces University Hospital Malnutrition would also lead to a delay in rehabilitation, a fundamental pillar in the recovery of these patients. The objective of starting it now in the ICU is “to avoid the weakness acquired by the hospitalization itself, to reduce the comorbidities associated with burn injuries and to achieve a better quality of life after recovery,” explains Dr. Jacinto Baena, an intensivist at Hospital Vall. d’Hebron. Therapies for skin elasticity From the first day of admission to the ICU, the patient’s motor recovery is prioritized, with postural and passive measured therapies that encompass both mobility and skin elasticity. These are accompanied by respiratory physiotherapy to recover adequate lung capacity, especially in patients who have experienced smoke inhalation. «In a second phase, we continue looking for a correct joint and postural balance, but we have already introduced re-education to carry out activities of daily living. Subsequently, it will be the turn to minimize and accept the consequences, with re-education focused on recovering the greatest possible autonomy,” adds Baena.

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