scholarly journals Early treatment and intensive care of children with burn injury

2017 ◽  
Vol 64 (1) ◽  
pp. 39-42
Author(s):  
Ivana Petrov ◽  
Ivana Budic ◽  
Irena Simic ◽  
Dusica Simic
Keyword(s):  
Pediatric Patients ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Physiological Status ◽  
Hormonal Responses ◽  
Severe Burns ◽  
Immunological Profile ◽  
Major Burn ◽  
Total Body

Major burn injury remains a significant cause of morbidity and mortality in pediatric patients. The treatment of burned children differs substantially from that of adults not only because of the different body proportions but also because of the metabolic processes involved, hormonal responses, the immunological profile, the degree of psychological maturation and healing potential. After assessing the overall physiological status of the child, accurate assessment of the burn injury and appropriate fluid resuscitation are of great importance. The severity of burn injury is characterized by the depth of the burn, total body surface area (TBSA) that is involved, the location of burn injury and the presence or absence of inhalation injury. Early excision and grafting, adequate nutrition, alleviation of the hypermetabolic response, treatment of hyperglycaemia, and physical therapy improve survival and outcomes in children with severe burns.

scholarly journals Restrictive Transfusion Strategy Is More Effective in Massive Burns: Results of the TRIBE Multicenter Prospective Randomized Trial

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 11-15 ◽  
Author(s):  
Tina L Palmieri ◽  
James H Holmes ◽  
Brett Arnoldo ◽  
Michael Peck ◽  
Amalia Cochran ◽  
...  
Keyword(s):  
Wound Healing ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Transfusion Strategy ◽  
Restrictive Transfusion ◽  
Blood Utilization ◽  
Outcome Differences ◽  
Total Body ◽  
Restrictive Transfusion Strategy

Abstract Objectives Studies suggest that a restrictive transfusion strategy is safe in burns, yet the efficacy of a restrictive transfusion policy in massive burn injury is uncertain. Our objective: compare outcomes between massive burn (≥60% total body surface area (TBSA) burn) and major (20–59% TBSA) burn using a restrictive or a liberal blood transfusion strategy. Methods Patients with burns ≥20% were block randomized by age and TBSA to a restrictive (transfuse hemoglobin <7 g/dL) or liberal (transfuse hemoglobin <10 g/dL) strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. Results Three hundred and forty-five patients received 7,054 units blood, 2,886 in massive and 4,168 in restrictive. Patients were similar in age, TBSA, and inhalation injury. The restrictive group received less blood (45.57 ± 47.63 vs. 77.16 ± 55.0, p < 0.03 massive; 11.0 ± 16.70 vs. 16.78 ± 17.39, p < 0.001) major). In massive burn, the restrictive group had fewer ventilator days (p < 0.05). Median ICU days and LOS were lower in the restrictive group; wound healing, mortality, and infection did not differ. No significant outcome differences occurred in the major (20–59%) group (p > 0.05). Conclusions: A restrictive transfusion strategy may be beneficial in massive burns in reducing ventilator days, ICU days and blood utilization, but does not decrease infection, mortality, hospital LOS or wound healing.

scholarly journals The predisposing factors of AKI for prophylactic strategies in burn care

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9984
Author(s):  
Shin-Yi Tsai ◽  
Chon-Fu Lio ◽  
Shou-Chuan Shih ◽  
Cheng-Jui Lin ◽  
Yu-Tien Chen ◽  
...  
Keyword(s):  
Burn Injury ◽  
Laboratory Data ◽  
Total Body Surface Area ◽  
Kidney Injury ◽  
Inhalation Injury ◽  
Predisposing Factors ◽  
Dust Explosion ◽  
Burn Care ◽  
Hospital Patients ◽  
Total Body

Background Acute kidney injury (AKI) is one of the most severe complications of burn injury. AKI with severe burn injury causes high mortality. This study aims to investigate the incidence of and predisposing factors for AKI in burn patients. Methods This is a single-center, retrospective, descriptive criterion standard study conducted from June 27, 2015, to March 8, 2016. We used Kidney Disease Improving Global Outcomes criteria to define and select patients with AKI. The study was conducted by recruiting in hospital patients who suffered from the flammable cornstarch-based powder explosion and were treated under primary care procedures. A total of 49 patients who suffered from flammable dust explosion-related burn injury were enrolled and admitted on June 27, 2015. The patients with more than 20% total body surface area of burn were transferred to the intensive care unit. Patients received fluid resuscitation in the first 24 hours based on the Parkland formula. The primary measurements were the incidence of and predisposing factors for AKI in these patients. Demographic characteristics, laboratory data, and inpatient outcomes were also evaluated. The incidence of AKI in this cohort was 61.2% (n = 30). The mortality rate was 2.0% (n = 1) during a 59-day follow-up period. The multivariate analysis revealed inhalation injury (adjusted OR = 22.0; 95% CI [1.4–358.2]) and meeting ≥3 American Burn Association (ABA) sepsis criteria (adjusted OR = 13.7; 95% CI [1.7–110.5]) as independent risk factors for early advanced AKI. Conclusions The incidence rate of AKI was higher in this cohort than in previous studies, possibly due to the flammable dust explosion-related burn injury. However, the mortality was lower than that expected. In clinical practice, indicators of inflammation, including ABA sepsis criteria may help in predicting the risk of AKI in patients with burn injury.

scholarly journals A paradigm shift in practice—the benefits of early active wound temporisation rather than early skin grafting after burn eschar excision

2020 ◽  
Vol 48 (2) ◽  
pp. 93-100
Author(s):  
John E Greenwood
Keyword(s):  
Skin Graft ◽  
Paradigm Shift ◽  
Burn Injury ◽  
Donor Site ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Graft Harvest ◽  
Major Burn ◽  
Early Closure ◽  
Total Body

After major burn injury, once survival is achieved by the immediate excision of all deep burn eschar, we are faced with a patient who is often physiologically well but with very extensive wounds. While very early grafting yields excellent results after the excision of small burns, it is not possible to achieve the same results once the wound size exceeds the available donor site. In patients where 50%–100% of the total body surface area is wound, we rely on serial skin graft harvest, from finite donor site resources, and the massive expansion of those harvested grafts to effect healing. The result is frequently disabling and dysaesthetic. Temporisation of the wounds both passively, with cadaver allograft, and actively, with dermal scaffolds, has been successfully employed to ameliorate some of the problems caused by our inability to definitively close wounds early. Recent advances in technology have demonstrated that superior functional and cosmetic outcomes can be achieved in actively temporised areas even when compared with definitive early closure with skin graft. This has several beneficial implications for both patient and surgeon, affecting the timing of definitive wound closure and creating a paradigm shift in the care of the burned patient.

97 Major Psychiatric Illness and Substance Use Disorder Influence Mortality in Major Burn Injury: A Secondary Analysis of the Transfusion Requirement in Burn Care Evaluation (TRIBE) Study

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S66-S67
Author(s):  
John A Andre ◽  
Soman Sen ◽  
David G Greenhalgh ◽  
Tina L Palmieri ◽  
Kathleen S Romanowski
Keyword(s):  
Psychiatric Illness ◽  
Transfusion Requirement ◽  
Total Body Surface Area ◽  
Secondary Analysis ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Burn Care ◽  
Major Burn ◽  
Total Body ◽  
Care Evaluation

Abstract Introduction Prior studies of burn patients with < 20% total body surface area (TBSA) burns have found that 15.4% of patients have major psychiatric illness (MPI) and 27.6% have Substance Use Disorder (SUD). In patients with small burns, SUD is associated with larger burn size and secondarily with longer length of stay while MPI is associated with longer lengths of stay while not increasing burn size. The purpose of this study was to determine whether MPI or SUD dependence affects outcomes such as mortality in patients with major burn injuries (≥20% TBSA). Methods A secondary analysis from the prospective, randomized, multicenter Transfusion Requirement in Burn Care Evaluation (TRIBE) study was conducted. Patients with MPI and SUD were compared with patients without these disorders. Statistical analysis with chi-square for categorical variables and student’s t-test for continuous variables was conducted. Mortality between those with and without MPI and SUD were analyzed with a multivariable regression analysis. Results A total of 347 patients with a mean age of 43±17 years, 274 men and 73 women, were analyzed. The mean total body surface area burn (TBSA) was 38±18%, and 23% had inhalation injury. In this study population, 29.1% had SUD, 7.5% had MPI, and 2.3% had both. There was no difference with respect to age, gender, TBSA, frailty, or assignment to the liberal or restrictive transfusion strategy based on the presence of MPI, SUD, or both. Inhalation injury was more common in patients with MPI (27%) or SUD (35%) when compared with patients without these comorbidities (18%) or those who have both (11%) (p=0.006). Patients with MPI were more likely to die of their burn injuries (27%) when compared with those with SUD (17%), both (11%), or neither (8%) (p=0.014). On multivariate analysis for mortality controlling for TBSA and inhalation injury, MPI was found to be an independent predictor of death with an odds ratio of 5 (95% confidence interval 1.7–15, p=0.003). Conclusions In burns >20% TBSA, both MPI and SUD influence patient’s likelihood of sustaining inhalation injury. MPI is also independently associated with mortality in the study. Further work must be done to mitigate the effects of mental illness on burn outcomes.

scholarly journals Nonmedical Factors Influencing Early Deaths in Burns: A Study of the National Burn Repository

2019 ◽  
Author(s):  
Rachel M Nygaard ◽  
Frederick W Endorf
Keyword(s):  
Socioeconomic Factors ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Early Period ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Commercial Insurance ◽  
Severe Burns ◽  
Hispanic Patients ◽  
Major Factors

Abstract It is well-established that survival in burn injury is primarily dependent on three factors: age, percent total-body surface area burned (%TBSA), and inhalation injury. However, it is clear that in other (nonburn) conditions, nonmedical factors may influence mortality. Even in severe burns, patients undergoing resuscitation may survive for a period of time before succumbing to infection or other complications. In some cases, though, families in conjunction with caregivers may choose to withdraw care and not resuscitate patients with large burns. We wanted to investigate whether any nonmedical socioeconomic factors influenced the rate of early deaths in burn patients. The National Burn Repository (NBR) was used to identify patients that died in the first 72 hours after injury and those that survived more than 72 hours. Both univariate and multivariate regression analyses were used to examine factors including age, gender, race, comorbidities, burn size, inhalation injury, and insurance type, and determine their influence on deaths within 72 hours. A total of 133,889 burn patients were identified, 1362 of which died in the first 72 hours. As expected, the Baux score (age plus burn size), and inhalation injury predicted early deaths. Interestingly, on multivariate analysis, patients with Medicare (p = .002), self-pay patients (p < .001), and those covered by automobile policies (p = .045) were significantly more likely to die early than those with commercial insurance. Medicaid patients were more likely to die early, but not significantly (p = .188). Worker’s compensation patients were more likely to survive the first 72 hours compared with patients with commercial insurance (p < .001). Men were more likely to survive the early period than women (p = .043). On analysis by race, only Hispanic patients significantly differed from white patients, and Hispanics were more likely to survive the first 72 hours (p = .028). Traditional medical factors are major factors in early burn deaths. However, these results show that nonmedical socioeconomic factors including race, gender, and especially insurance status influence early burn deaths as well.

Sem And Tem Observations of Rat Trachea and Lung After Inhalation Injury and Cutaneous Burn In a Rat Model

1999 ◽  
Vol 5 (S2) ◽  
pp. 1176-1177
Author(s):  
P.C. Langlinais ◽  
D.W. Mozingo ◽  
M.A. Dubick ◽  
S.C. Carden ◽  
C.W. Goodwin
Keyword(s):  
Burn Injury ◽  
Small Animal ◽  
Inhalation Injury ◽  
Smoke Inhalation ◽  
Tree Bark ◽  
Sprague Dawley ◽  
Smoke Inhalation Injury ◽  
Severe Burns ◽  
Total Body ◽  
Large Animals

Inhalation injury is present in 32-38% of patients with severe burns and is associated with an increase of 20-84% above the mortality expected based on age and burn size alone. Most previous studies of smoke inhalation injury have utilized large animals such as the sheep and we have previously reported a TEM and SEM study of lung injury in the sheep. The present observations are part of a study to develop a small animal combined model of smoke inhalation and surface burn.Adult, male Sprague-Dawley rats were used. Animals were anesthetized and randomly assigned to one of four groups. Groups 1 and 2 received a 20% total body area surface (TBSA) full thickness scald burns while groups 3 and 4 were sham treated. Five hours after burn injury, rats were placed in a nose only exposure device and half of each group was exposured to either room air alone or room temperature tree bark smoke for 16.25 minutes.

Meeting the Challenge of Analgesia in a Pregnant Woman With Burn Injury Using Subanesthetic Ketamine: A Case Report and Literature Review

2020 ◽  
Vol 41 (4) ◽  
pp. 913-917 ◽  
Author(s):  
Akshay B Roy ◽  
Liam P Hughes ◽  
Lindsay A West ◽  
Eric S Schwenk ◽  
Yasmin Elkhashab ◽  
...  
Keyword(s):  
Pain Management ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Interdisciplinary Treatment ◽  
Complete Analysis ◽  
Third Trimester ◽  
Management Guidelines ◽  
The Third ◽  
Severe Burns ◽  
Total Body

Abstract Pain management guidelines for burn injury in pregnant women are scarce. Maternal and fetal morbidity and mortality in pregnant burn patients have been shown to be higher than that of the general population, especially in severe burns. Early intervention and interdisciplinary treatment are critical to optimize maternal and fetal outcomes. Proper pain management is central to wound treatment, as poor control of pain can contribute to delayed healing, re-epithelialization, as well as persistent neuropathic pain. We present this case of a 34-year-old female patient who suffered an 18% total body surface area burn during the third trimester of pregnancy to demonstrate that ketamine can be considered as an adjunct for procedural and background analgesia during the third trimester, as part of a multimodal strategy in a short-term, monitored setting after a thorough and complete analysis of risks and benefits and careful patient selection.

scholarly journals Clinical Practice Variation in Acute Severe Burn Injury

2018 ◽  
Vol 46 (3) ◽  
pp. 321-325 ◽  
Author(s):  
T. L. Garside ◽  
R. P. Lee ◽  
A. Delaney ◽  
D. Milliss
Keyword(s):  
Intensive Care ◽  
Clinical Practice ◽  
Best Practice ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Practice Variation ◽  
Inhalation Injury ◽  
Severe Burns ◽  
Significant Difference ◽  
Inhalational Injury

The New South Wales (NSW) Statewide Burn Injury Service Database was reviewed to identify variations in clinical practice with respect to care of severely burn-injured patients in intensive care. We compared differences in practice relating to duration of endotracheal intubation and surgical grafting. In this retrospective observational study, we reviewed all intensive care unit (ICU) admissions to the two NSW adult burns centres, ICU A and ICU B, between January 2008 and December 2015. Data were analysed for association between duration of intubation and outcome. There were 855 admissions to adult ICU, with a significant difference in the percentage total body surface area (% TBSA) of burn and inhalation injury between patients in the two units. There was a significant difference in duration of intubation and ICU length of stay (LOS) between the units, which persisted when adjusted for age, % TBSA and inhalational injury. When analysing patients with more severe burns (>20% TBSA or intubated), the difference in duration of intubation remained significant (median of three days [interquartile range, IQR, 1–11 days] in A and 2 days [IQR 1–6 days] in B, P=0.003) as did ICU LOS (median 3 days [IQR 2–11 days] for A and 2 days [IQR 1–6 days] for B, P <0.0005). There was no significant difference in mortality between the two units for the severe or the more severe subgroup of burns when adjusted for age, % TBSA and inhalational injury (adjusted odds ratio, OR, for mortality 1.17 [95% confidence intervals 0.6 to 2.3, P=0.65]). There were significant differences in clinical practice, including duration of intubation, between the two ICUs. Longer intubation was associated with a longer ICU LOS, but was not associated with a difference in mortality. Large collaborative, prospective multicentre studies in severe burns are needed to identify best practice and variations in practice to determine if they are associated with increased mortality and/or cost.

Early Transcriptomic Response to Burn injury: Severe Burns are Associated with Immune Pathway Shutdown

2021 ◽  
Author(s):  
John W Keyloun ◽  
Ross Campbell ◽  
Bonnie C Carney ◽  
Ruoting Yang ◽  
Stacy-Ann Miller ◽  
...  
Keyword(s):  
Injury Severity ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Transcriptomic Response ◽  
Severe Burns ◽  
Regional Center ◽  
Differential Gene Regulation ◽  
Differential Gene ◽  
Total Body ◽  
Immune Pathway

Abstract Burn injury induces a systemic hyperinflammatory response with detrimental side effects. Studies have described the biochemical changes induced by severe burns, but the transcriptome response is not well characterized. The goal of this work is to characterize the blood transcriptome after burn injury. Burn patients presenting to a regional center between 2012-2017 were prospectively enrolled. Blood was collected on admission and at predetermined time points (hours 2, 4, 8, 12, 24). RNA was isolated and transcript levels were measured with a gene expression microarray. To identify differentially regulated genes (FDR≤0.1) by burn injury severity, patients were grouped by total body surface area (TBSA) above or below 20% and statistically enriched pathways were identified. Sixty-eight patients were analyzed, most patients were male with a median age of 41 (IQR, 30.5-58.5) years, and TBSA of 20% (11-34%). Thirty-five patients had %TBSA injury ≥20%, and this group experienced greater mortality (26% vs. 3%, p=0.008). Comparative analysis of genes from patients with &lt;/≥20% TBSA revealed 1505, 613, 380, 63, 1357, and 954 differentially expressed genes at hours 0, 2, 4, 8, 12 and 24 respectively. Pathway analysis revealed an initial upregulation in several immune/inflammatory pathways within the ≥20% TBSA groups followed by shutdown. Severe burn injury is associated with an early proinflammatory immune response followed by shutdown of these pathways. Examination of the immunoinflammatory response to burn injury through differential gene regulation and associated immune pathways by injury severity may identify mechanistic targets for future intervention.

scholarly journals Burn Cases, Their Management and Complications: A Review

2016 ◽  
Vol 5 (12) ◽  
pp. 103-105 ◽  
Author(s):  
Rizwan Ali Masood ◽  
Zafeer Naeem Wain ◽  
Rehan Tariq ◽  
Muhammad Asis Ullah ◽  
Irfan Bashir
Keyword(s):  
Cardiogenic Shock ◽  
Body Surface ◽  
Fluid Resuscitation ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Pharmaceutical Journal ◽  
Review Article ◽  
Major Burn ◽  
Silver Compound ◽  
Total Body

Skin being the primary barrier to infection can be damaged by burn injury. Burn injury may lead to distributive, hypovolemic and cardiogenic shock. A burn victim may experience several extremely mortal complications i.e. local and systemic. When the injury exceeds 25 to 30% total body surface area (TBSA) there will be the chances of generalized edema in non-injured tissues. Fluid resuscitation is very effective method in the management of major burn. According to the expert opinion, the fluid resuscitation should be started in adults with 15% and children with 10% burns. In this review article, it has been concluded that opioids, anticonvulsants, antidepressants, benzodiazepines and ketamine are the most commonly used drugs in the management of burn pain. Silver compound or its salts mainly Silver sulfadiazine is an important remedy in topical treatment. Sepsis is the main cause of death in burn victims.Masood et al., International Current Pharmaceutical Journal, November 2016, 5(12): 103-105http://www.icpjonline.com/documents/Vol5Issue12/01.pdf

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