Introduction

Most severely burned patients will need the facilities of an intensive care unit (ICU), at least initially, for the management of hypovolemia, smoke inhalation, associated injuries, and pre-existing conditions. Ideally, such patients should be in a burn ICU; however, many ICUs will receive the occasional burned patient and the decision must be made either to keep and treat the patient or to transfer him or her to a specialized facility. Such decision making requires a knowledge of the support that an individual patient may need as well as the probable outcome. Approximately 10 per cent of burned patients will require prolonged intensive care, with an average stay of about 25 days (Lingnau , .et, al 1996).

The American Burn Association has produced detailed and specific recommendations for burn care facilities ( Am®E!caniiiiBurn.,Associaii,o.D 19.9.0). However, a well-functioning burn ICU requires both an appropriate facility and a team of burn care specialists, including surgeons, intensivists, nurses, therapists, and many others. Burn ICUs must have space available for all the usual ICU equipment, such as ventilators and portable X-ray machines, but also need additional space for performing wound care. The potential for cross-infection is increased in an overcrowded unit. Individual rooms with isolation facilities and separate air-handling systems are strongly recommended for burns greater than 50 to 60 per cent. The unit must also have effective individual temperature control because of the excessive heat loss associated with burn injury. ICUs caring for burned patients have all the standard requirements, including adequate electrical and gas lines, and space for medications and charting, but the storage needs are generally much greater because of the large quantities of wound care supplies often needed daily for each patient. Typically, a unit in the United States will be directed by either a general surgeon or a plastic surgeon with additional experience in burn care and a head nurse/manager with both intensive care and burn experience. A number of medical specialists must be available, including additional intensivists, anesthesiologists, internists, psychiatrists, etc. The nursing care of seriously burned patients requires at least a one-to-one ratio, and this must often be supplemented by technicians and aides to assist with wound care and other activities. An array of other specialists is required to provide optimum care, including respiratory therapists, occupational and physical therapists, and social workers. The rehabilitation process is often deferred until the patient is past the critical stage of his or her injury. Unfortunately, such delays often result in permanent impairment or unnecessarily prolonged rehabilitation.

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