Background

Worldwide, for major burn patients (≥15% body surface area for adults and ≥10% in children), little is known about current practice for temperature monitoring and thermoregulatory support. There are no universally agreed, precise thresholds for definitions of hypothermia, normothermia or hyperthermia or for the best methods to monitor and alter body temperature. 

It has long been recognised that patients who receive major burn injuries are at risk of developing hypothermia. The reasons for this are multifactorial but include the loss of the thermoregulatory capacity of the skin when it is damaged by heat and the circulatory shunting of blood away from the peripheries to the core as part of the stress response. Burns often require surgery and the tendency to develop hypothermia can be exacerbated by the effects of anaesthetic drugs and other factors around the time of the operation. Perioperative hypothermia has been associated with the development of multiple deleterious consequences, from coagulopathy to sudden death. Conversely, burn patients also can develop high body temperatures (hyperthermia) in the intermediate term due to inflammatory modulation of the hypothalamic thermoregulation and the susceptibility to septicaemia due to relative immunosuppression and loss of the skin barrier.

This study aims to establish current practice in managing patient body temperature for burns patients undergoing surgery in burn centres across Europe and Australasia.

We are not setting out to compare the efficacy of different temperature control methods. Rather, we aim to identify the consensus of current working infrastructure and attitudes regarding burn patient body temperature control. As part of this aim, we seek to answer a few limited, but vital questions including:

• Are local protocols/guidelines in widespread use concerning burn patient body temperature management?
• What are the patient body temperatures which relevant healthcare professionals consider safe during, and around the time of, surgery?
• What are the methods burn centres are currently using in order to monitor and influence patient body temperature?

It is hoped that by gathering this evidence and presenting the results, we will stimulate debate within the burns healthcare community. In the absence of level I evidence regarding thermoregulation and temperature assessment, understanding current practice is an essential step towards stimulating debate and normalising care across the burns community.