Temperature management of adult burn patients in intensive care: findings from a retrospective cohort study in a tertiary centre in the United Kingdom

Abstract

Introduction: Patients with major burn injury are prone to hypothermia, potentially resulting in an increase in mortality and length of hospital stay. Our study comprehensively evaluates the practicalities of physiological thermoregulation and temperature control in the largest cohort of critically ill adult burn patients to date.

Material and methods: This retrospective study of routinely collected patient data from the Intensive Care Unit (ICU) of the West Midlands Burn Centre was conducted over a three-year period (2016-2019). Data were analysed to assess temperature control against local and International Society for Burn Injury (ISBI) standards.

Results: Thirty-one patients with significant burn injuries, requiring active critical care treatment for more than 48 hours were included (total body surface area [TBSA] mean = 42.7%, SD = 18.1%; revised Baux score [rBaux] = 99, SD = 25). The majority were male (77.29%) with an average age of 44 years (17-77 years). The patients were cared for in the ICU for a total of 15 119 hours. Hypothermia, defined as core temperature below 36.0°C, was recorded for 251 hours (2% of total stay). Only 27 patients (87%) had their temperature ≥ 36°C for more than 95% of their admission. Non-survivors were more prone to hypothermia during their stay in ICU. There was an association between rBaux score and post-opera-tive temperature, with a 0.12°C decrease per 10 points increase in rBaux score (P = 0.04).

Conclusions: We have observed a high variability of temperature control between individual patients, especially in non-survivors, and have demonstrated an association between high rBaux score and poor temperature control, specifically during the postoperative period.

Keywords: adult; burn; critical care; hyperthermia; hypothermia; intensive care; intensive therapy; temperature; thermoregulation; surgery.

FIGURE 1

Flow chart summarising the selection of patients using inclusion and exclusion criteria

FIGURE 2

Hourly temperatures during (A) first 48 hours of the Intensive Care Unit (ICU) admission and (B) whole ICU admission

FIGURE 3

Percentage of time temperatures were maintained in the ranges (A) 38.5 ± 1°C and (B) 36°C and above. The 80% threshold for 38.5 ± 1°C and 95% threshold for ≥ 36°C are demonstrated on the graph

FIGURE 4

Ranges of body temperature following return to the Intensive Care Unit from the operating theatre. 87% of patients were normothermic (≥ 36°C) and the remaining 13% hypothermic (< 36°C). 71% of patients were within the range 38.5 ± 1°C

FIGURE 5

Association between (A) revised Baux score (rBaux score) and (B) total body surface area (TBSA) and core body temperature on return from theatre. There was a 0.12°C reduction in temperature for every 10 point increase in rBaux score (β = –0.12, 95% CI: –0.03°C to –0.21°C, P = 0.04). The negative association between TBSA and core body temperature after theatre did not reach statistical significance