• Rolf K Gigengack, van Baar Margriet E ME Association of Dutch Burn Centers, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, , Berry I Cleffken, Jan Dokter, and Cornelis H van der Vlies.
• Department of Trauma and Burn Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands; Department of Anesthesiology, Amsterdam UMC, Location VU Medical Center, Boelelaan 1117, 1081HV Amsterdam, The Netherlands. Electronic address: gigengackr@maasstadziekenhuis.nl.
• Burns. 2019 Aug 1; 45 (5): 1057-1065.

PurposeMortality in burn intensive care unit (ICU) has been decreasing and treatment appears to be changing. The aims of this study: (1) examine outcome in burn patients, (2) examine changes in ICU indication and (3) explore the influence of a changing case-mix.MethodsRetrospective study in patients admitted to ICU (1987-2016). Four groups were specified: major burns (≥15% TBSA), inhalation injury with small injury (<15% TBSA, inhalation injury), watchful waiting (<15% TBSA, without inhalation injury), tender loving care (patients withheld from treatment). Logistic regression was performed to evaluate the relation between case-mix and outcome.ResultsOverall mortality decreased to 7%. Mortality of major burns decreased by 15%. The major burn group decreased by 36%. The inhalation injury and watchful waiting group increased by 9% and 21%. The percentage of ventilated patients increased by 14% in the major burn group. 40% of patients were ventilated in the watchful waiting group.ConclusionsAfter correction for case-mix, survival improved, mainly in the major burn group. Case-mix shifted towards inhalation injury and watchful waiting. Growth of the watchful waiting group is not necessarily harmful. However, the increase of mechanical ventilation could be. We suggest raising awareness for risks and consequences of mechanical ventilation.Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.

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