Prevention and treatment of gastrointestinal dysfunction following severe burns: a summary of recent 30-year clinical experience.
OBJECTIVE
To sum up the recent 30-year experience in the prevention and treatment of gastrointestinal dysfunction in severe burn patients, and propose practicable guidelines for the prevention and treatment of gastrointestinal (GI) dysfunction.


METHODS
From 1980 to 2007, a total of 219 patients with large area and extraordinarily large area burns (LAB) were admitted, who were classified into three stages according the therapeutic protocols used at the time: Stage 1 from 1980 to 1989, stage 2 from 1990 to 1995, and stage 3 from 1996 to 2007. The occurrence and mortality of GI dysfunction in patients of the three stages were calculated and the main causes were analyzed.


RESULTS
The occurrence of stress ulcer in patients with LAB was 8.6% in stage 1, which was significantly lower than that in stage 1 (P < 0.05). No massive hemorrhage from severe stress ulcer and enterogenic infections occurred in stages 2 and 3. The occurrence of abdominal distension and stress ulcer and the mortality in stage 3 patients with extraordinarily LAB was 7.1%, 21.4% and 28.5%, respectively, which were significantly lower than those in stage 1 patients (P < 0.05 or P < 0.01), and the occurrence of stress ulcer was also significantly lower than that in stage 2 patients (P < 0.05).


CONCLUSIONS
Comprehensive fluid resuscitation, early excision of necrotic tissue, staged food ingestion, and administration of specific nutrients are essential strategies for preventing gastrointestinal complications and lowering mortality in severely burned patients.
Xiao
Shi-Chu
SC
Department of Burn Surgery, Changhai Hospital, Second Military Medical University, 174 Changhai Road, Shanghai 200433, China.
Zhu
Shi-Hui
SH
Xia
Zhao-Fan
ZF
Lu
Wei
W
Wang
Guang-Qing
GQ
Ben
Dao-Feng
DF
Wang
Guang-Yi
GY
Cheng
Da-Sheng
DS
D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000517:prevention & control; D002056:Burns / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002648:Child; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008875:Middle Aged; D010437:Peptic Ulcer / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D013312:Stress, Physiological; D016896:Treatment Outcome