[Physiological responses and initial treatment of extensive burns]

Two hundred and twenty seven patients with extensive burns were treated at our department during the period 1975 to 1984, the overall mortality rate being 48.5%. Physiological responses were analysed after dividing the patients into three groups according to the year of treatment, the first group consisting of 83 patients treated during 1976-1978, the second group of 81 patients treated during 1979-1981 and the third group of 55 patients treated during 1982-1984. Survival rates increased gradually during this period, the rates being 44.6%, 54.3% and 56.4% in the first, second and third groups, respectively. It is believed that these improvements resulted from substantial changes in therapy between each period, which include: estimation of hemodynamics for early volume resuscitation; massive fluid resuscitation with lactated Ringer's solution and protein, which ameliorates the shock and acute renal failure due to burns; rapid institution of nutritional support and early grafting essential in preventing infection and sepsis. Significant improvements in survival rates were noted after more aggressive treatment.