DÄ internationalArchive6/2010Benefits of Cooling Are Not Known
LNSLNS The benefits of cold water therapy in stopping a burn injury from penetrating deeper into the tissues has been shown in some animal models, but only if the proportion of body surface that was burnt was 1–5% and the treatment was initiated immediately. Waiting for only a few minutes after the trauma has been sustained immediately negates any beneficial effect. If the treatment is administered for too long or the temperature is too cold then the tissue necrosis will be more extensive. The authors recommend cooling the burnt skin surface for (20 to) 30 minutes; a time period that we think is very clearly too long. In our view, cold water therapy is a lay or first-aid measure. The first step to be taken by the ambulance services or the emergency physician should be to immediately cease the cooling or heat treatment. The German Society for Burn Treatment (www.verbrennungsmedizin.de) recommends cooling therapy with tap water only for small burns; we think it is contraindicated in patients with large surface burns. The recommendations from the Deutscher Feuerwehrverband (the German Fire Services Association) express similar sentiments (2).

The statement that no guidelines are available for the nutrition of burned patients is incorrect. The European Society for Parenteral and Enteral Nutrition’s 2006 guidelines include such aspects and recommendations (3).
DOI: 10.3238/arztebl.2010.0101a

Dr. med. Tomislav Trupkovic
Dr. med. Uwe Hoppe
Prof. Dr. med. Stefan Kleinschmidt
Ludwig-Guttmann-Str. 13
67071 Ludwigshafen, Germany

Prof. Dr. med. Peter Sefrin
Sandweg 11
97078 Würzburg, Germany
1.
Lönnecker S, Schoder V: Hypothermie bei brandverletzten Patienten – Einflüsse der präklinischen Behandlung. Chirurg 2001; 72: 164–7. MEDLINE
2.
Deutscher Feuerwehrverband: Stellungnahme zur Kühlung von Brandwunden 2003. www.dfv.org
3.
Kreymann K, Berger M, Deutz M: ESPEN Guidelines on enteral nutrition: intensive care. Clin Nutr 2006: 25; 210–23. MEDLINE
4.
Spanholtz TA, Theodorou P, Amini P, Spilker G: Severe burn injuries—acute and long-term treatment [Versorgung von Schwerstverbrannten: Akuttherapie und Nachsorge]. Dtsch Arztebl Int 2009: 106: 607–13. VOLLTEXT
1. Lönnecker S, Schoder V: Hypothermie bei brandverletzten Patienten – Einflüsse der präklinischen Behandlung. Chirurg 2001; 72: 164–7. MEDLINE
2. Deutscher Feuerwehrverband: Stellungnahme zur Kühlung von Brandwunden 2003. www.dfv.org
3. Kreymann K, Berger M, Deutz M: ESPEN Guidelines on enteral nutrition: intensive care. Clin Nutr 2006: 25; 210–23. MEDLINE
4. Spanholtz TA, Theodorou P, Amini P, Spilker G: Severe burn injuries—acute and long-term treatment [Versorgung von Schwerstverbrannten: Akuttherapie und Nachsorge]. Dtsch Arztebl Int 2009: 106: 607–13. VOLLTEXT