[Application of multidisciplinary team diagnosis and treatment model in the management of patients with combined burns and heat stroke].

Objective

To explore the application of multidisciplinary team (MDT) diagnosis and treatment model in the management of patients with combined burns and heat stroke.

Methods

This study was a retrospective observational study. From January 2022 to December 2024, the Military Burn Center admitted 5 patients and the Department of Critical Care Medicine of the 990th Hospital of PLA Joint Logistic Support Force admitted 4 patients with combined burns and heat stroke that met the inclusion criteria. All patients were male, aged 64-78 (70±5) years. The onset of the disease in patients occurred mainly during June to September, with the time frame predominantly between 10:00 and 14:30, in environment with temperature>30 ℃ and humidity≥60%. Under the MDT diagnosis and treatment model, a fixed MDT was established with the director of the Military Burn Center as the leader, which included specialists from critical care medicine, nephrology, respiratory medicine, cardiology, neurology, anesthesiology, endocrinology, pharmacy, rehabilitation, nutrition, and transfusion medicine. Through clear division of responsibilities, standardized information communication, and daily interdisciplinary handovers, integrated coordination and decision-making in the diagnosis and treatment process were achieved. The burn-related characteristics including total burn area, burn index, and combination of inhalation injury, treatment including infusion rate in the first 24 h post admission, infusion rate in the second 24 h post admission, and total infusion rate within 48 h post admission, use of blood products, status of continuous blood purification (CBP) treatment, administration of invasive mechanical ventilation, and timing of the first surgery, outcomes including length of intensive care unit (ICU) stay, total hospital stay, and mortality within 7 days after admission of patients were recorded.

Results

The total burn area of patients was 22.6% (10.5%, 23.0%) total body surface area, the burn index was 12.5 (8.0, 13.5), and 5 patients were combined with inhalation injury. The infusion rate in the first 24 h post admission, infusion rate in the second 24 h post admission, and total infusion rate within 48 h post admission of 7 patients were significantly higher than the planned fluid infusion rates (with t values of 4.39, 8.58, and 3.69, respectively, P<0.05). Blood products were used in 6 patients. CBP was performed in 3 patients with an average duration of 64.7 h, and invasive mechanical ventilation was applied in 4 patients with an average duration of 60.0 h. Five patients underwent surgery, with the first surgery performed at 13-19 (16.0 (13.7, 19.0)) days post admission. The patients' length of ICU stay was 0-504 (216 (18, 252)) h, and the total hospital stay was 0.5-71.0 (11.0 (1.4, 46.5)) d. Four patients died within 7 days after admission.

Conclusions

Patients with combined burns and heat stroke are characterized by relatively limited burn area, frequent inhalation injury, and large volume of fluid resuscitation, thus facing clinical challenges such as the need for multiple ways of organ support and delayed surgical timing. In this context, the MDT diagnosis and treatment model centered on the department of burns and department of critical care medicine provides a rational pathway for coordinating complex resuscitation management, organ function support, and decisions on the timing of surgery.