Care of patients with burns and traumatic brain injury

The combination of thermal injury and traumatic brain injury (TBI) poses a significant resuscitation challenge. Limited data exist on the effect of severe burns (>20 % of the total body surface area) on the brain. These data suggest that even in the absence of TBI, burns may cause disruption of the blood-brain barrier (BBB). Burn patients require large volumes (2-4 ml/kg/% burn) of fluid for resuscitation during the first 24 h postburn. This, combined with loss of BBB integrity, may cause cerebral edema during the early postburn period. In patients with TBI and burns, close attention to parsimonious fluid management; liberal use of intracranial pressure monitoring during resuscitation; and careful consideration of alternative approaches to include hypertonic saline or mannitol infusion may be required.