Abstract
Introduction: Nursing care for patients with severe burns involves three major challenges: management of body temperature, management of wounds, and management of pain. This study investigated the currently recommended care based on guidelines with a literature review.
Body temperature management for patients with extensive burns: Avoiding hypothermia is essential in patients with extensive burns and the following measures are advised: 1）Establish target room temperatures tailored to specific situations（shock phase, perioperative period, management in the intensive care unit, etc.）and monitor body temperature. 2）In the perioperative period, combine active rewarming（e.g., with a warm air blanket）with management of appropriate room temperature and shortening of operative time.
Management of burn wounds: The recommended treatment for third-degree burns is excision of the burn wound and early wound closure such as using skin grafts. Extensive third-degree burns require the management of large amounts of exudate until the wound closes. However, few studies have examined this issue, warranting future study.
Analgesia and sedation for patients with burns: Several guidelines related to analgesia and sedation have been published based on a large body of evidence and are applied in practice. However, studies in this area are insufficient regarding patients with burns. The current recommendations are as follows: 1）Sedation is unnecessary as long as analgesia is instituted. 2）Opioids（fentanyl, etc.）are the first-line drugs for pain management in wound care. The dose of opioids can be reduced by combining them with other analgesics and/or sedatives, including acetaminophen, nonsteroidal anti-inflammatory drugs, propofol, dexmedetomidine (Precedex®), and ketamine. 3）Pain should be regularly evaluated using pain assessment tools such as the Behavioral Pain Scale, Critical-Care Pain Observation Tool, and Numeric Rating Scale. 4）Pregabalin (Lyrica®) can be considered for neuropathic pain.
