Management of bleeding in major burn surgery

Area of Science:

• Trauma Surgery
• Anesthesiology
• Critical Care Medicine

Background:

• Major burn surgery frequently involves significant bleeding and massive transfusions.
• Coagulopathy development during burn surgery is linked to higher morbidity and mortality rates.

Purpose of the Study:

• To review existing literature on intraoperative hemostatic resuscitation strategies for burn patients undergoing necrectomy.
• To identify current practices in hemostatic monitoring and resuscitation during major burn surgeries.

Main Methods:

• A systematic literature search was conducted in PubMed, EMBASE, and CENTRAL for studies from 2006-2017.
• The search focused on bleeding complications, coagulopathy, transfusion needs, and clinical outcomes in burn surgery.
• Six studies were included in the final review after initial screening of 1375 identified papers.

Main Results:

• Transfusion requirements correlate positively with burn injury severity.
• Hemostatic monitoring via thrombelastography (TEG) or rotational thromboelastometry (ROTEM) significantly reduced intraoperative transfusions.
• TEG/ROTEM proved useful in predicting and guiding hemostatic therapy during excision surgery.

Conclusions:

• Resuscitation strategies for bleeding during major burn surgery are often unstandardized and lack a hemostatic focus.
• Resuscitation should prioritize achieving normal hemostasis through diligent monitoring and targeted therapy.
• Further randomized controlled trials are essential to validate the benefits of this hemostatic resuscitation approach.