[Severely burned patients: epidemiology and treatment (a study of 104 Gabonese cases)]

This retrospective study was carried out over five years (August 1993 to August 1998) and included 104 patients admitted to the intensive care unit for heat-induced or electrical burns affecting more than 10% of their total body surface area. Most of the patients were children or young adults and the mean age of the group was 24 years. Seventy-eight of the patients were the victims of domestic fires. The other 26 cases involved work-related burns and car accidents. Most of the burns observed were caused by fire or scalding, but there were also two cases of electrical burns. Lesions affected predominantly the head (45.1%), upper limbs (31.5%) and perineum (5.8%). Hemodynamic rescuscitation and intensive respiratory care were administered initially, along with topical surgical treatment. Triple antibiotic treatment was also given immediately in cases of shock or burns to the body's natural orifices. If triple antibiotic treatment was not administered immediately then, within six hours of the burn, treatment was given to prevent infection with Staphylococcus aureus and soil-borne microorganisms and anti-tetanus vaccination was adminstered systematically. The treatment was then modified to prevent infection with Gram-negative bacilli, common second-stage microoganisms. The bacteria most frequently isolated, particularly from the skin and urine, were Pseudomonas (52%), Escherichia coli (37.5%) and Staphylococcus aureus (10.5%). Enteral and parenteral nutrition was begun as soon as possible. The presence of the patient's family during care and rehabilitation was of great psychological benefit to the patients. The mean duration of hospital stay was 12 days. In those cases in which the patient died, early death (within one week) was due to respiratory distress and hydroelectrolytic problems whereas deaths after the first week were due to septic shock. The overall death rate was 54.8%. Prevention should be taught, with particular emphasis on those at high risk.