Burn management during the COVID-19 pandemic: recommendations and considerations

Abstract

Coronavirus disease-2019 (COVID-19) is a respiratory disease, caused by a novel coronavirus (SARS-COV-2). This disease has been raising international public health concerns since its recent outbreak in December 2019. As the virus is easily transmitted by respiratory droplets, all hospital departments needed to change their practices in an attempt to control the spread of this virus. Burn units and clinics are particularly affected by this pandemic because of the larger risk of contamination for both patients and caregivers. Furthermore, cross-clinical aspects especially pain management and complications such as coagulopathy might be caused by both extensive burns and COVID-19 infections, which makes the management of these patients particularly challenging. That’s why we covered both main aspects in this review. In addition, we present briefly a synthesis of guidelines from several entities to help manage the health crisis and provide optimal care for all burn patients during this pandemic. Highlights: • All new burn patients, including pediatric burn patients, should undergo solitary isolation for 3–5 days, 14 days is recommended if possible, for medical observation. • Preliminary screening, which includes blood routine and chest CT examinations, is performed routinely on all newly admitted patients. • Severe burn patients should be admitted to burn intensive care unit (BICU) and should be treated as suspects of COVID-19. • Sputum absorption, airway lavage, and other invasive operations should be minimized as much as possible. • For urgent surgeries, lung CT and routine blood tests must be performed right before any surgical procedure, and the COVID-19 PCR test should be performed based on clinical symptoms and epidemiology. • Surgery is the highest risk point of COVID-19 infection exposure especially in the early treatment of burn patients. • For patients with negative COVID-19 testing, urgent procedures have to be administrated in negative-pressure operating rooms, and healthcare staff must take proper protective precautions. • Patients are advised to do an online check-in and share their status and improvement of rehabilitation. • It is recommended to suspend the rehabilitation treatment with close contact. • The therapeutic strategy for underlying pain management in COVID-19 burn patients remains similar to the regular burn patients; however, more attention for the opioid administration should be paid. • Burn patients associated with COVID-19 require strict monitoring and follow-up. Routine chemical venous thromboembolism (VTE) prophylaxis should be also applied. An escalated dose VTE prophylaxis should be seriously considered as the risk of coagulopathy notably increases in such cases.

Keywords

• burn management
• coagulopathy
• coronavirus
• pain management