Survey about target temperature and thermal management in intensive care for severe thermal trauma in burn centres of Germany, Austria and Switzerland

Abstract

Burn trauma induces hypermetabolism and alters thermoregulation resulting in elevated body temperature. Because patients with burns are prone to heat loss and hypothermia, maintaining physiologic body temperature is important. However, optimal target temperature is widely unknown because thermoregulation of burn trauma has mainly been studied in the previous century, when treatment concepts differed from current era. The aim of this study was to investigate current thermal management of burn treatment and to investigate the discrepancies between classical concepts of thermoregulation in burn trauma and current practice of temperature management. A paper-based survey was conducted in burn centres in Germany, Austria, and German-speaking Switzerland. Participants were asked for expected temperatures, temperature goals, and thermal management of severely burned patients. Results were evaluated for adults and children. 37 of 38 approached burn centres participated in this survey. 59 % expected that adults with burn trauma would develop hyperthermia (>37.5 °C) but only 27 % expected hyperthermia in children (>38 °C). The average target body temperature was 37.1 °C for adults and 36.9 °C for children. Adults below 35.7 °C and children below 36.0 °C were assessed to be hypothermic. Temperatures above 38.8 °C in adults and 38.7 °C in children raised suspicion for sepsis. Antipyretic treatment was assumed to be justified at temperatures above 39.1 °C in adults and 38.5 °C in children. Although the most common warming method was to increase ambient temperature, 89 % of all participants felt their wellbeing was affected by an increased ambient temperature and 68 % were concerned about temperature-related negative effects. Although 57 % of the responding centres had established a standard operating procedure for thermal management, only 41 % considered the available literature to be very relevant in daily practice and 89 % criticized the lack of guidelines. Limit and target temperatures in European burn centres are heterogeneous. Classic concepts of thermal management in burn care are not universally adopted. A majority of the centers expresses the need for specific guidelines. The basis for this should be multicentre clinical trials on temperature management in burn trauma.