engleski

Psychopharmacotherapy in the treatment of burn injured patients

Objectives: Sustaining a burn injury is often a traumatic experience, with long-term physical and psychosocial effects. There is the growing evidence for the need of holistic approach to pharmacotherapy of severely burned patients, including psychopharmacotherapy for the sedation and amelioration of psychosocial problems associated with burns, as well as for pain control. The purpose of this study was to retrospectively review the records of adult burn patients regarding the use of psychotropic agents in their treatments. Methods: The 193 patients with severe burns, who were hospitally treated during the year 2003 at the University Hospital of Traumatology, Zagreb, Croatia, were selected as the sample for this study. From the patients included in the study, 121 (62, 69%) were males, 72 (37, 31%) were females, aged between 14 and 96 (mean age was 50, 06). The hospital stay ranged from 1 to 180 days (average = 20, 73 days). The extent of their injures ranged from small (63, 2%, n = 122), large (29%, n = 56) and extensive (7, 77%, n = 15).The mean burned total body surface area (TBSA) was 26, 63%. The depth of the burns ranged from first-degree (1, 03%, n = 2), second-degree (IIA 23, 31%, n = 45 ; IIB 34, 71%, n = 67), third-degree (38, 86%, n = 75), to fourth-degree (2, 07%, n = 4). The mortality rate was 6, 74% (n = 13). On the base of medical records the authors analysed the classes of psychotropic agents prescribed to patients as well as their average daily doses. Also, the authors analysed whether the patients had previous psychiatric history, as well as the localization of burns. Results: Psychotropic agents have been prescribed for all patients. The medication most frequently prescribed in treating anxiety was diazepam (69, 43%, n=134). Midazolam was readily utilized in the preoperative treatment and for the sedation of patients with mechanically assisted ventilation. Among hypnotics, patients were mostly treated with zolpidem (11, 4%). Antidepressants were prescribed too little comparing to the perceived prevalence of depression and their use as adjuvant therapy for pain. Among antipsychotics, patients were mostly treated with haloperidol. Pain medication were prescribed to all hospitalized patients, mostly tramadol. The average daily dose of tramadol was 300 mg. Tramadol has important interactions with other psychotropic drugs, which must be considered. Conclusions: The seriously burned patient need psychotropic agents from the time of injury to full recovery, and this need is increasing as modern burn centers are dramatically improving survival rates. Psychopharmacotherapy alone is rarely sufficient to provide complete remission of psychological disturbances of burn patients. Further research on efficacy and interactions of psychotropic drugs will help us in our clinical work. It is necessary to incorporate psychopharmacotherapy in the algorithm of treatment of burn injured patients

burn injuries; phychopharmacotherapy; tramadol

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