A Study of Sepsis in Severe Burn Patients for 5 Years

PURPOSE: The aim of this study was epidemiologic research on morbidity rate changes and causes of sepsis in severe burn patients, as they are highly vulnerable to sepsis which is closely related to mortality rate. METHODS: A retrospective review was conducted on 1,026 patients admitted to Burn Intensive Care Unit (BICU) of Hangang Sacred Heart Hospital from September 2011 to December 2015. Age, sex, burn size, whether the patient has inhalation injury, LOS (length of stay), LOSICU (Length of Stay in the Intensive Care Unit), and route of infection were taken into account. RESULTS: The average age, total body surface area (TBSA), the degree of inhalation injury, abbreviated burn severity index (ABSI), acute physiology and chronic health valuation score (APACHE) II, and LOS were higher in the dead than the survivors, and the differences were statistically significant. Incidence rate of sepsis was also meaningfully higher in the dead group, 64.8%. Patients with sepsis had higher average age, degree of inhalation injury, TBSA, and LOS, showing statistically significant differences as well compared to patients without sepsis. For five years from 2011 to 2015, rates of severe burn patients diagnosed with sepsis were 43.3%, 54.3%, 46.4%, 51.9%, and 43.9% respectively. CONCLUSION: Severe burn patients with higher age, larger burn size, and inhalation injury require more careful monitor as they are likely to be infected with sepsis. In addition, more laboratory parameters for early detection of sepsis need to be developed, so that follow-up studies can be conducted on prognostic factors correlated to sepsis.

A Clinical Study of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Efficacy of Treatment in Burn Intensive Care Unit

PURPOSE: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), potentially life-threatening skin diseases with organ failures caused by drugs, require specialized intensive care. However, SJS and TEN have usually been managed in general wards and intensive care units by most doctors. This study describes the efficacy of treatment in the burn intensive care unit (BICU) compared to previous general treatments. METHODS: To investigate the clinical features, outcomes and benefits of 11 patients with SJS and TEN treated in our burn intensive care unit. Data on 11 patients who were treated between January 2004 and December 2008 were collected via a retrospective chart review. Also, the data were reviewed with previous literatures on SJS and TEN treatments. RESULTS: Patients were classified with overlap SJS/TEN (n=4, 36.36%) or TEN (n=7, 63.64%). Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most common causative agents. Hepatitis was the most common organ involvement in both overlap SJS/TEN (n=1, 9.1%) and TEN (n=4, 36.36%). Renal dysfunction (n=4, 36.36%) and respiratory disorders (n=3, 27.27%) were seen in some cases. Mean time of total reepithelization was 9 days and mean hospital day was 14.66 days. Two patients with TEN died from sepsis with multi-organ failure, and the mortality rate was 18.18%. CONCLUSION: Adequate treatment of SJS and TEN in the BICU supports efficacy with a low mortality rate, short healing time, short hospitalization and fewer complications.