Determining when care for burns is futile

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Burn Management

Background:

• Patient survival after burn injuries is influenced by age, burn size, inhalation injury, and comorbidities.
• These factors are also critical in determining the futility of aggressive burn care.
• Objective criteria are needed to guide decisions regarding the cessation of intensive treatment.

Purpose of the Study:

• To develop objective criteria for identifying futility in burn care.
• To establish guidelines for decision-making when further therapeutic interventions are unlikely to benefit burn patients.

Main Methods:

• Retrospective review of 3301 patient records admitted to a Burn Center from 1986 to 1994.
• Analysis of factors including age, burn size, inhalation injury, and organ dysfunction.
• Examination of mortality data and the implementation of do-not-resuscitate orders.

Main Results:

• A total of 114 deaths (3.45%) occurred during the study period.
• 44 deaths occurred early in the hospital course, while 70 occurred later.
• Do-not-resuscitate with comfort-measures-only orders were issued for 33 patients (26.7%).

Conclusions:

• Objective criteria, incorporating age, burn extent, inhalation injury, and organ dysfunction, can be developed.
• These criteria can assist in determining the futility of further therapy at admission or during progressive multi-organ failure.
• This approach aids in making difficult decisions regarding end-of-life care for severely burned patients.