[The present strategy and ponderation on prevention and treatment of burn sepsis and multiple organ dysfunction syndrome (MODS)].
Most of the major advances in the prevention and treatment of burn sepsis and MODS have been made within the last 20 years. Improvements have been made in gaining a better understanding of the pathophysiology of burn sepsis and MODS, in revising the definition of sepsis and MODS, and in prevention and treatment of burn shock. Additionally, improvements have been made in fluid resuscitation in patients with burn shock and in early gastrointestinal feeding to prevent translocation of endotoxins from the gut. Other achievements have been made in using recombinant human growth hormone combined with intensive insulin therapy to control hyperglycemia, and potassium chloride to prevent hypokalemia in order to accelerate protein synthesis. Additional advances include early closure and coverage of the burn wound, rational use of antibiotics, immunological modulation to combat immunological dissonance. Also, advances have been made by using early anticoagulation treatment to prevent coagulopathy. In prevention and treatment of burn sepsis and MODS, comprehensive support for all organs during the course of treatment is emphasized. Although the advances in burn treatment have been extremely encouraging over the last 50 years, burn sepsis and MODS remain the most common cause of mortality in the critical ill. To cope with extreme environmental conditions, such as armed conflict and natural disasters, research is needed to optimize the oral resuscitation regime, and more efficacious treatment strategies that are based on an indepth understanding of the pathogenesis of sepsis.
Chai
Jia-ke
JK
Institute of Burn Research, the First Affiliated Hospital to the PLA General Hospital, Beijing 100037, P.R. China.
Sheng
Zhi-yong
ZY
D002056:Burns / Q000150:complications / Q000378:metabolism*; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology / Q000517:prevention & control*; D018805:Sepsis / Q000209:etiology / Q000517:prevention & control*