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May 1991

Severe Hypothermia Occurring During the Course of Toxic Epidermal Necrolysis in Patients Treated With Air-Fluidized Beds

Author Affiliations

The Burn Center Hôpital d'Instruction des Armées Percy 92141 Clamart, France

Arch Dermatol. 1991;127(5):739. doi:10.1001/archderm.1991.01680040151022

To the Editor.—  More than one aspect of toxic epidermal necrolysis (TEN) can manifest with extensive burn injuries. For instance, according to most authors, fluidized air beds (Clinitron Support System International, Montpelier, France) are recommended in the management of TEN when a large portion of skin is destroyed on the patient's backside.1,2 This device permits the wounds to dry, avoids maceration, and facilitates the skin's healing. But the constant air flow of this device may increase the patient's daily evaporative water losses by 5 to 6 L, making the management of fluid and electrolyte balance more delicate. However, keep in mind that 1 L of water needs about 2520 kJ to evaporate. Last year, caring for three patients with TEN with 95% skin loss, on the average, confronted us with the following difficulty: severe hypothermia rapidly developed in all three patients, the lowest average temperature being 34.6°C with a

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