Early mobilization (EM) of intensive care (IC) patients is important but complex with facilitators and barriers. Compared to general IC patients, burn IC patients are more hyper-metabolic. They have extensive wounds, lengthy wound dressing changes, and repeated surgeries that may affect possibilities of EM. This study aimed to identify facilitators and barriers of EM in burn IC patients among all disciplines involved. Additionally, we assessed EM practices, i.e. when are which patients considered suitable for EM. A survey was sent to 139 professionals involved in EM of burn IC patients (discipline groups: Intensivists, medical doctors, registered nurses, therapists). Response rate was 57 %. The majority found EM very important, yet different definitions were chosen. Perceived barriers mainly concerned patient-level factors, most frequently hemodynamic instability and excessive sedation followed by skin graft surgery, fatigue, and pain management. Most frequent barriers at the provider-level were limited staffing, safety concerns, and conflicting perceptions about the suitability of EM. At the institutional-level, we found no high barriers. Interdisciplinary variation on perceived barriers, when to initiate it, and permitted maximal activity were ascertained. Skin grafts and pain management were barriers of EM specific for burn care. Opinions on frequency, dosage and duration of EM varied widely. Improving interdisciplinary communication is key.

Introduction: It is difficult to adjust fluid balance adequately in patients with severe burns due to various physical changes. B-type natriuretic peptide (BNP) is emerging as a potential marker of hydration state. Proteinuria is used as a predictor of outcome in severe illness and might correlate to systemic capillary leakage. This study investigates whether combining BNP and proteinuria can be used as a guide for individualized resuscitation and as a predictor of outcome in patients with severe burns. Methods: From 2006 to 2009, 38 consecutive patients (age 47 ± 15 years, 74% male) with severe burns were included and followed for 20 days. All had normal kidney function at admission. BNP and proteinuria were routinely measured. Ordered and actually administered fluid resuscitation volumes were recorded. The Sequential Organ Failure Assessment (SOFA) score was used as the measure of outcome. Results: BNP increased during follow-up, reaching a plateau level at Day 3. Based on median BNP levels at Day 3, patients were divided into those with low BNP and those with high BNP levels. Both groups had comparable initial SOFA scores. Patients with high BNP received less fluid from Days 3 to 10. Furthermore, patients with a high BNP at Day 3 had less morbidity, reflected by lower SOFA scores on the following days. To minimize effects of biological variability, proteinuria on Days 1 and 2 was averaged. By dividing the patients based on median BNP at Day 3 and median proteinuria, patients with high BNP and low proteinuria had significantly lower SOFA scores during the entire follow-up period compared to those patients with low BNP and high proteinuria. Conclusions: Patients with higher BNP levels received less fluid. This might be explained by a lower capillary leakage in these patients, resulting in more intravascular fluid and consequently an increase in BNP. In combination with low proteinuria, possibly reflecting minimal systemic capillary leakage, a high BNP level was associated with a better outcome. BNP and proteinuria have prognostic potential in severely burned patients and may be used to adjust individual resuscitation.

Background: Burns occur frequently in young children. To date, insufficient data are available to fully describe the functional consequences of burns. In different patient populations and countries, the WeeFIM instrument (“WeeFIM”) often is used to measure functional independence in children. Objective: The purpose of this study was to examine the psychometric properties of the WeeFIM instrument for use in Dutch burn centers. Design: This was an observational study. Methods: The WeeFIM instrument was translated into Dutch. All clinicians who rated the children with the instrument passed the WeeFIM credentialing examination. They scored consecutive children (n=134) aged 6 months to 16 years admitted to Dutch burn centers with acute burns during a 1-year period at 2 to 3 weeks, 3 months, and 6 months postburn. To examine reliability, 2 raters scored a child at the same time (n=52, 9 raters) or the same rater scored a child twice within 1 week (n=7, 3 raters). Results: After a few weeks, the WeeFIM assessment could be administered in less than 15 minutes. Clinicians thought it was difficult to rate a child aged between 2 and 4 years as well as the cognitive items. Nevertheless, reliability was good (all intraclass correlation coefficients [1,1] were above .80). The standard error of measurement was 3.7. Limitations: Intrarater reliability was based on only 7 test-retest measurements. Within our clinical setting, it turned out to be difficult to schedule the same rater and patient twice in one week for repeated assessments. Assessments for interrater reliability, on the other hand, worked out well. Conclusions: The WeeFIM instrument is a feasible and reliable instrument for use in children with burns. For evaluation of a child's individual progress, at least 11 points' improvement should be observed to state that a child has significantly improved.