Introduction

Advances in critical care monitoring have contributed significantly to the recent improvement in survival after major thermal injury. Monitoring of the burn patient is a complex process that involves all life support systems throughout the resuscitation and wound care phases of burn treatment. Specific therapeutic interventions are dictated by a multitude of clinical factors as well as the result of intensive, often sophisticated, monitoring.

Assessment of the burned patient during the acute care phase may require varying levels of monitoring on a continuous or intermittent basis. Young healthy patients with minor burn injuries may only require the occasional periodic assessment of vital signs, whereas those with greater risk factors will often demand a greater intensity of monitoring.

Monitoring must be both physiologically appropriate and clinically useful in the management of the burned patient. The importance of repeated bedside observations and evaluation cannot be overstated. Before utilizing the newer invasive modalities, one must weigh the risks and benefits of each monitoring method. Moreover, it is extremely important that the burn team develop a clinical protocol listing indications and techniques for obtaining certain physiological data.

Factors in assessing monitoring needs

A number of clinical factors must be considered when assessing monitoring needs in burned patients. These include burn size, inhalation injury, associated injuries, and pre-existing medical condition.

Burn size

Patients with minor burn injuries who present without additional complicating factors generally will not require admission to the Burn Unit for intensive care monitoring. Patients meeting the American Burn Association (ABA) Burn Center referral criteria for moderate or major injury often develop large fluid shifts, haemodynamic instability, and alterations in biochemical status.