Dr Morgan Haines1, Dr Lachlan Donaldson2, Ms Katelyn Davies2, Ms Frances Bass2, Dr Varun Harish1, A/Prof Anthony Delany2
1Department of Burns, Maxillofacial, Plastic and Reconstructive Surgery, Royal North Shore Hospital, St Leonards, Australia, 2Intensive Care Unit, Royal North Shore Hospital, St Leonards, Australia
Abstract:
Background: Prevention of hypothermia is a tenet of initial burns management despite a paucity of evidence to support this practice. The goal of normothermia in the early management of severe burns may reflect the poor outcomes seen with hypothermia in trauma patients. Meanwhile first aid with burn cooling has been shown to be favourable in burn injuries but predisposes to hypothermia. We hypothesised hypothermia in severely-burn injured patients would be associated with poorer clinical outcomes. Methods: Retrospective analysis of the Royal North Shore (RNS) Burns Outcomes from Intensive Care Database between 2017-2021. Results: 115 patients were analysed. The median temperature for patients at their first hospital was 35.6 degrees and at RNS ICU was 35.5 degrees. 38.5% (n=45) of patients were hypothermic and 11.1% (n=13) had temperatures under 33.5 degrees. The risk of mortality was significantly higher amongst those presenting with hypothermia (RR2.4, 95%CI 1.02-5.83, p=0.0375). However, when controlled for age, BSA, inhalational injury, smoking, full thickness burns, and wound infection, hypothermia was not associated with mortality (p=0.67), nor was severe hypothermia (p=0.121). Discussion: The incidence of hypothermia was 38.5% at presentation to the initial hospital suggesting that initial resuscitation practices are focused elsewhere. That average core temperature on arrival to ICU was equivocal to initial core temperature demonstrates patient warming during transfer is infrequently addressed. The multivariate analysis on mortality suggests hypothermia may not be as important to prevent poor outcomes as other principles such as fluid resuscitation. Conclusion: Prevention of hypothermia does not influence mortality in this study.
Biography:
Burns and plastic surgery registrar