The practice of restrictive transfusion is slowly gaining
traction.
Abdominal compartment syndrome is associated with
resuscitation volumes of 300 ml/kg per 24 h, and percutaneous
decompression may be a treatment option.
Adrenal insufficiency is common, but whom and when to treat are unclear. Imaging or noninvasive monitoring may confirm renal perfusion before urine output, and the concept of permissive
hypovolemia should be explored. There is progress in the laboratory in
smoke inhalation and myocardial depression, but no human translation.
Antibiotic pharmacokinetics in large
burns are unpredictable, and so
aminoglycosides (measurable concentrations) are not obsolete. Selective digestive decontamination remains controversial. Nutritional predictions by formula are inaccurate.
Oxandrolone is safe and effective in promoting anabolism in large
burns.
Deep venous thrombosis prophylaxis remains guided only by expert opinion. Females fare worse than male patients after
burns.
SUMMARY: The application of the scientific method to
burn care is improving slowly. Randomized controlled trials are becoming more common. There is a need for translation of excellent animal work to the human arena.