596 ICU Sedation Practices for Mechanically Ventilated Burn Patients Following Guideline Implementation

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S141-S141
Author(s):  
Jeffrey H Anderson ◽  
Samuel P Mandell
Keyword(s):  
Management Practices ◽  
Burn Injury ◽  
Guideline Implementation ◽  
Single Agent ◽  
Retrospective Chart Review ◽  
Opioid Analgesics ◽  
Burn Patients ◽  
Background Pain ◽  
The Difference ◽  
Icu Sedation

Abstract Introduction Our American Burn Association verified regional burn center has approximately 700 admissions for burn injury per year, 200 of which are admitted to the burn intensive care unit (BICU). Sedation practices during acute burn resuscitations remain variable. In order to standardize our sedation practices, we developed a Background Pain and Anxiety Decision Tree for Mechanically Intubated Adults in March 2017. Concern over hypotension led to the removal of propofol as the sedative of choice. The new protocol made midazolam the primary choice and recommended the use of adjunct analgesics, including acetaminophen, for background pain. It uses the Richmond Agitation Sedation Scale (RASS) to determine whether patients were oversedated (RASS< 0) or anxious (RASS >1+). Methods We conducted a single center retrospective chart review on intubated patients admitted to the BICU from November 2017 through November 2018. Data collection focused primarily on sedation practices during this time to determine whether our protocol had the desired effects. Highest and lowest RASS were collected, and the difference between the two (delta RASS) was used to determine changes in patient agitation and sedation. Results Thirty three adult patients requiring mechanical ventilation were admitted to the BICU between November 2017 and November 2018. Of these patients, 21 (66%) received propofol on hospital day one, and 12 (38%) received propofol on hospital day two. Eleven patients received both propofol and midazolam on hospital day one. Of these patients, the average propofol dose was 511 micrograms per day and the average midazolam dose was 13.3mg per day (p=0.02). Eighteen (56%) and twenty five (78%) patients received acetaminophen on hospital days one and two, respectively. Twenty four patients had a RASS recorded during their first hospital day. The average highest RASS recorded was 1.3 and the average lowest recorded RASS was -3.2. Patients who received both propofol and midazolam had a higher peak RASS (2.4) and a lower minimum RASS (3.4), creating a larger delta RASS for this group. Conclusions Despite eliminating propofol from our sedation guidelines, its use remains the predominant mode of sedation for burn patients throughout the first forty eight hours of hospitalization. There is also room for improvement for administration of non-opioid analgesics, including acetaminophen. Finally, our ventilated patients tend to be more oversedated than undersedated, and a combination of midazolam and propofol creates the largest swings in patients’ sedation and agitation status. Applicability of Research to Practice Changing sedation and pain management practices in the ICU is a multifactorial process that requires more than ICU guideline implementation. The use of two sedatives during the first hospital day can result in larger swings in RASS as opposed to use of a single agent.

Follow up after burn injury is disturbingly low and linked with social factors

2021 ◽  
Author(s):  
Irina P Karashchuk ◽  
Eve A Solomon ◽  
David G Greenhalgh ◽  
Soman Sen ◽  
Tina L Palmieri ◽  
...  
Keyword(s):  
Social History ◽  
Drug Dependence ◽  
Burn Injury ◽  
Retrospective Chart Review ◽  
Burn Patients ◽  
Chi Square ◽  
Factors Associated ◽  
Ed Visits ◽  
Zip Code

Abstract For medical and social reasons, it is important that burn patients attend follow up appointments (FUAs). Our goal was to examine the factors leading to missed FUAs in burn patients. A retrospective chart review was conducted of adult patients admitted to the burn center from 2016-2018. Data collected included burn characteristics, social history, and zip code. Data analysis was conducted using chi-square, Wilcox Rank Sum tests, and multivariate regression models. A total of 878 patients were analyzed, with 224 (25.5%) failing to attend any FUAs and 492 (56.0%) missing at least one appointment (MA). Patients who did not attend any FUAs had smaller burns (4.5 (8)% vs. 6.5 (11)% median (inter quartile range)), traveled farther (70.2 (111.8) vs. 52.5 (76.7) miles), and were more likely to be homeless (22.8% vs. 6.9%) and have drug dependence (47.3% vs. 27.2%). Patients who had at least one MA were younger (42 (26) vs. 46 (28) years) and more likely to be homeless (17.5% vs. 2.6%) and have drug dependence (42.5% vs. 19.4%). On multivariate analysis, factors associated with never attending a FUA were: distance from hospital (odds ratio (OR) 1.004), burn size (OR 0.96), and homelessness (OR 0.33). Factors associated with missing at least one FUA : age (OR 0.99), drug dependence (OR 0.46), homelessness (OR 0.22), and ED visits (OR 0.56). A high percentage of patients fail to make any appointment following their injury and/or have at least one MA. Both FUAs and MAs are influenced by social determinants of health.

53 Frailty is Not Only a Phenomenon of Elderly Burn Patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S38-S39
Author(s):  
Kathleen S Romanowski ◽  
Melissa J Grigsby ◽  
Soman Sen ◽  
Tina L Palmieri ◽  
David G Greenhalgh
Keyword(s):  
Chart Review ◽  
Burn Injury ◽  
Frailty Index ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Burn Injuries ◽  
Burn Patients ◽  
Chi Square ◽  
Frail Patients ◽  
Modified Frailty Index

Abstract Introduction Recent evidence indicates that increased frailty is associated with increased mortality in patients with burn injuries over the age of 50 years old. This work found that 35.7% of burn patients over 65 years old were frail at the time of their burn admission while 19.2% of burn patients 50 to 64 years old were frail. While frailty is associated with increased age the two are separate entities suggesting that frailty may be present in much younger patients who present with burn injuries. We hypothesize that frailty exists in all age groups of patients presenting with burn injury and the prevalence increases with age. Methods Following IRB approval, a 5-year (2014–2019) retrospective chart review was conducted of all burn patients admitted to the burn center. Data collected includes age, gender, and burn size (% TBSA). Frailty was determined using the Modified Frailty Index 11 (MFI 11) from co-morbidities included in the burn registry. Patients were considered frail if they have an MFI ³ 2 and pre-frail for an MFI³1 and < 2. Patients were assessed by decades for age. Statistical analysis included descriptive statistics, chi-square, and t-tests. Results A total of 2173 patients (mean age 46.1±17.3 years, 1584 males (72.8%), mean % TBSA 12.5±16.3%) were analyzed. All age groups included patients who were pre-frail (Table 1). In the under 20-year-old group, 8.5% were pre-frail. This increases with each age group to the 71-80-year-old group in which 41.7% of patients are pre-frail. The over 80-year-old group had slightly fewer pre-frail patients (35.9%). There were no frail patients in the under 20-year-old group. In the 21–30 there were 3 patients (0.7%) that had an MFI of 2 or more placing them in the frail group. Frailty was significantly different across the age groups (p< 0.001). As patients age, the proportion of female patients increases (from 17.6% to 37.5%. p< 0.0001). Frailty was also associated with gender with women having a higher percentage of frailty (p=0.0006). With respect to burn size, age category was not associated with burn size (p=0.12), but frail patients had smaller burns than non-frail or pre-frail patients (9.5% vs. 13.3% vs. 12.2%, p=0.0002). Conclusions Pre-frail patients were identified in all age groups. Frailty was present in all age groups except for those who are under 20 years of age. Frailty was associated with female sex and smaller burns. By not specifically looking for frailty in all burn patients admitted to the hospital we are potentially missing frail patients who may benefit from interventions to improve their outcomes.

65 Pain Management Practices in the Elderly Patient with Burn Injury

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S46-S47
Author(s):  
Ciara Hutchison ◽  
Rita Gayed ◽  
Rohit Mittal
Keyword(s):  
Pain Management ◽  
Pain Control ◽  
Management Practices ◽  
Burn Injury ◽  
Management Strategies ◽  
Total Body Surface Area ◽  
Operative Therapy ◽  
The Elderly ◽  
Burn Patients ◽  
Opioid Use

Abstract Introduction Opioids are key to pain management in burns but have increased side effects like falls and delirium in the elderly. However, comorbidities prevalent in this population (e.g., chronic kidney disease) limit use of non-opioid adjuncts, making pain control for these patients a difficult balance. Little data exists regarding pain control practices in elderly burn patients. We aim to retrospectively characterize pain management strategies (including opioids and non-opioid adjuncts) in this patient population. Methods This is a retrospective cohort of patients age >65 with burns < 20% total body surface area (TBSA) admitted to the burn stepdown unit from 2014 to 2019. The primary outcome was to quantify opioid use inpatient and at discharge in morphine milligram equivalents (MME). Secondary outcomes included percent of patients receiving opioids and adjunct analgesics at these timepoints. Mean MME inpatient vs. at discharge were compared using paired t-test. Percent of patients receiving opioids and non-opioid adjuncts were compared using McNemar’s test. Results One hundred elderly patients (mean age 73.9, SD 6.7) with mean TBSA of 5.6% (SD 4.5) were included. Fifty-two percent required autografting; the remainder received porcine or non-operative therapy. Mean daily inpatient MME was 18.0 (SD 20.8) and mean discharge MME was 28.0 (SD 20.5) (p=.001), equivalent to 12mg and 18.5mg of oral oxycodone. Inpatient, 72% of patients received opioids vs. 83% at discharge (p=.041). Acetaminophen was the most commonly prescribed non-opioid adjunct inpatient and at discharge; other adjuncts like non-steroidal anti-inflammatories (NSAIDs) and gabanoids were infrequently used. Conclusions Elderly burn patients are discharged with more opioids than utilized while inpatient. Aside from acetaminophen, non-opioid adjuncts used commonly in younger patients such as NSAIDs and gabanoid medications are under-utilized, presumably due to concern for comorbidities.

Radiographic Prevalence of Osteochondrosis in Yearling Feral Horses

1999 ◽  
Vol 12 (03) ◽  
pp. 151-155 ◽  
Author(s):  
L. W. Valentino ◽  
E. M. Gaughan ◽  
D. R. Biller ◽  
R. H. Raub ◽  
J. D. Lillich
Keyword(s):  
Subchondral Bone ◽  
Management Practices ◽  
Articular Surface ◽  
Radiographic Images ◽  
Feral Horses ◽  
Metacarpophalangeal Joints ◽  
Genetic Base ◽  
Domestic Horses ◽  
The Difference ◽  
Metatarsophalangeal Joints

The purpose of the study is to document the prevalence of articular surface osteochondrosis lesions in feral horses. Eighty yearling feral horses were used. Radiographic images of the left stifle, both tarsocrural, metatarsophalangeal, metacarpophalangeal joints were taken. Radiographs were examined for the presence of osteochondral fragmentation and abnormal outline of subchondral bone suggestive of osteochondrosis. The prevalence of each lesion was calculated for each joint as well as for overall prevalence within the group, the latter being 6.25%. Typical osteochondrosis lesions were found within the tarsocrural and metatarsophalangeal joints. Based on the difference in prevalence of osteochondrosis between feral and certain domestic horses, management practices and perhaps genetic base may have a greater influence on the development of the disease in horses than trauma alone.

531 The Effect of Burn Wound Size on Caloric Requirements: A Correlation of Nutritional Changes to the Clinical State

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S113-S114
Author(s):  
Marc R Matthews ◽  
Sara Calder ◽  
Areta Kowal-Vern ◽  
Philomene Spadafore ◽  
Karen J Richey ◽  
...  
Keyword(s):  
Injury Severity ◽  
Burn Injury ◽  
Recovery Period ◽  
Total Body Surface Area ◽  
Caloric Intake ◽  
Retrospective Chart Review ◽  
Clinical State ◽  
Apache Score ◽  
Burn Wound ◽  
Caloric Requirements

Abstract Introduction Caloric intake has been a vital component for burn wound healing and recovery. The hypothesis was that caloric requirements are based on injury severity & post-burn week as predicated by indirect calorimetry (IC)/predictive equations. Methods This was a retrospective chart review of 115 burn patients (2012–2017). Caloric requirements were determined by the Curreri equation [which includes % total body surface area (TBSA)] and IC for a 5-week period provided mainly by enteral nutrition. Patients received supplements and total parenteral nutrition as needed. Results The mean ±sd age was 43±18 years, 41±18 % TBSA, Body Mass Index of 28±7 kg/m2, and mortality of 26 (23%). The major mechanisms of injury were flame/flash/explosions. There were 59 (51%) of patients with < 40 % TBSA burns, [median Injury Severity Score (ISS) 9; Apache score 14], and 56 (49%) with ≥40 % TBSA (median ISS 25; Apache score 21), p < .0001. The Respiratory Quotient (RQ) had a median of 0.94 (range 0.79 to 1.02). The median number of surgeries for the < 40 % TBSA group was 5 versus 12 for the ≥40 % TBSA, p < .0001. The Injury Factor did not differ from weeks 1–5 (1.8 for < 40 % TBSA and 2.0 for the ≥ 40 % TBSA). The Curreri equation calculation for this study was a median 3640 (range 2161–5950) calories. The Curreri equation resulted in significantly increased caloric recommendations for the ≥ 40 %TBSA compared to the < 40 %TBSA patients, p < .0001. The < 40 %TBSA group had caloric requirements ranging between 1500- 2700 calories compared to the ≥ 40 %TBSA group, whose calories ranged between 2000–3700. The total daily caloric recommendations were also significantly increased in the ≥40 %TBSA compared to the < 40 %TBSA patients. The maximum levels of resting energy expenditure (REE) from IC, total daily calories recommended by the dietitian and average calories ranged between 3000–4500 in the < 40 %TBSA group and 3600–6700 in the ≥ 40 %TBSA group. The caloric recommendations increased for all patients from week 1 to week 3 and leveled off during weeks 4–5. Conclusions Patient caloric requirements were dependent not only on the severity of the burn injury but also the post-burn hospitalization during which surgeries, debridement/grafting, and infectious complications occurred. They increased until the third week post-burn and leveled off in the recovery period. The study caloric recommendations and requirements were consistent with the REE and Curreri equation assessments.

11 Vitamin D Deficiency on Admission and the Association with Length of Stay in Patients with Thermal Injury: A Multi-center Analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S13-S14
Author(s):  
Sarah Zavala ◽  
Kate Pape ◽  
Todd A Walroth ◽  
Melissa A Reger ◽  
Katelyn Garner ◽  
...  
Keyword(s):  
Vitamin D ◽  
Length Of Stay ◽  
Vitamin D Deficiency ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Comfort Care ◽  
The Impact

Abstract Introduction In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). Methods This was a multi-center retrospective study of adult patients at 7 burn centers admitted between January 1, 2016 and July 25, 2019 who had a 25-hydroxyvitamin D (25OHD) concentration drawn within the first 7 days of injury. Patients were excluded if admitted for a non-burn injury, total body surface area (TBSA) burn less than 5%, pregnant, incarcerated, or made comfort care or expired within 48 hours of admission. The primary endpoint was to compare hospital LOS between burn patients with vitamin D deficiency (defined as 25OHD < 20 ng/mL) and sufficiency (25OHD ≥ 20 ng/mL). Secondary endpoints include in-hospital mortality, ventilator-free days of the first 28, renal replacement therapy (RRT), length of ICU stay, and days requiring vasopressors. Additional data collected included demographics, Charlson Comorbidity Index, injury characteristics, form of vitamin D received (ergocalciferol or cholecalciferol) and dosing during admission, timing of vitamin D initiation, and form of nutrition provided. Dichotomous variables were compared via Chi-square test. Continuous data were compared via student t-test or Mann-Whitney U test. Univariable linear regression was utilized to identify variables associated with LOS (p < 0.05) to analyze further. Cox Proportional Hazard Model was utilized to analyze association with LOS, while censoring for death, and controlling for TBSA, age, presence of inhalation injury, and potential for a center effect. Results Of 1,147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, p < 0.001), acute kidney injury (AKI) requiring RRT (7.3 vs 1.7%, p = 0.009), more days requiring vasopressors (mean 1.24 vs 0.58 days, p = 0.008), and fewer ventilator free days of the first 28 days (mean 22.9 vs 25.1, p < 0.001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, the best fit model included only deficiency and days until vitamin D initiation. Conclusions Patients with thermal injuries and vitamin D deficiency on admission have increased length of stay and worsened clinical outcomes as compared to patients with sufficient vitamin D concentrations.

scholarly journals Surviving Burn Injury: Drivers of Length of Hospital Stay

2021 ◽  
Vol 18 (2) ◽  
pp. 761
Author(s):  
Chimdimma Noelyn Onah ◽  
Richard Allmendinger ◽  
Julia Handl ◽  
Ken W. Dunn
Keyword(s):  
Mental Status ◽  
Burn Injury ◽  
Length Of Hospital Stay ◽  
Care Plan ◽  
Burn Patients ◽  
Emotional Needs ◽  
Effective Care ◽  
Significant Difference ◽  
Unitary Model ◽  
Hospital Resources

With a reduction in the mortality rate of burn patients, length of stay (LOS) has been increasingly adopted as an outcome measure. Some studies have attempted to identify factors that explain a burn patient’s LOS. However, few have investigated the association between LOS and a patient’s mental and socioeconomic status. There is anecdotal evidence for links between these factors; uncovering these will aid in better addressing the specific physical and emotional needs of burn patients and facilitate the planning of scarce hospital resources. Here, we employ machine learning (clustering) and statistical models (regression) to investigate whether segmentation by socioeconomic/mental status can improve the performance and interpretability of an upstream predictive model, relative to a unitary model. Although we found no significant difference in the unitary model’s performance and the segment-specific models, the interpretation of the segment-specific models reveals a reduced impact of burn severity in LOS prediction with increasing adverse socioeconomic and mental status. Furthermore, the socioeconomic segments’ models highlight an increased influence of living circumstances and source of injury on LOS. These findings suggest that in addition to ensuring that patients’ physical needs are met, management of their mental status is crucial for delivering an effective care plan.

scholarly journals Outcomes of Femtosecond Laser Assisted Cataract Surgery Performed by Resident and Attending Surgeons

2021 ◽  
Vol 13 (01) ◽  
pp. e26-e31
Author(s):  
Spencer C. Cleland ◽  
Daniel W. Knoch ◽  
Jennifer C. Larson
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Cataract Surgery ◽  
Retrospective Chart Review ◽  
Dissipated Energy ◽  
Independent Practice ◽  
Postoperative Visual Acuity ◽  
Included Patient ◽  
Duration Of Surgery ◽  
The Difference

Abstract Objective The study aimed to evaluate the safety and efficacy of resident surgeons performing femtosecond laser assisted cataract surgery (FLACS). Methods A retrospective chart review was conducted at the University of Wisconsin-Madison from postgraduate year four residents performing FLACS between 2017 and 2019. Data were also collected from residents performing manual cataract surgery, and attending surgeons performing FLACS for comparison. Recorded data included patient demographics, pre- and postoperative visual acuity, pre- and postoperative spherical equivalent, nuclear sclerotic cataract grade, ocular and systemic comorbidities, intraocular lens, duration of surgery, cumulative dissipated energy (CDE), and intraoperative and postoperative complications. Results A total of 90 cases were reviewed with 30 resident manual cases, 30 resident FLACS cases, and 30 attending FLACS cases. Resident manual (25.5 ± 6.8 minutes) and resident FLACS (17.5 ± 7.1 minutes) cases took a significantly longer time to complete compared with attending FLACS cases (13.6 ± 4.4 minutes; p < 0.001). There was higher CDE in resident FLACS and resident manual cases compared with attending FLACS cases, but the difference was not statistically significant (p = 0.06). Postoperative visual acuity was not statistically different at 1-day and 1-month after surgery among the three groups. Resident FLACS complications, which included one case requiring an intraoperative suture to close the wound, two cases with intraoperative corneal abrasions, two cases with postoperative ocular hypertension, and one case with cystoid macular edema, were not significantly greater than attending FLACS complications (p = 0.30). Conclusion The FLACS performed by resident surgeons had comparable visual acuity outcomes to FLACS performed by attending surgeons, and to manual cataract surgery performed by resident surgeons. However, resident FLACS cases took significantly longer time to complete, and they were associated with a higher CDE and minor complication rate compared with attending FLACS cases. Introducing advanced technologies into surgical training curricula improves resident preparedness for independent practice, and this study suggests FLACS can be incorporated safely and effectively into resident education.

scholarly journals Once-Daily Amikacin Dosing in Burn Patients Treated with Continuous Venovenous Hemofiltration

2011 ◽  
Vol 55 (10) ◽  
pp. 4639-4642 ◽  
Author(s):  
Kevin S. Akers ◽  
Jason M. Cota ◽  
Christopher R. Frei ◽  
Kevin K. Chung ◽  
Katrin Mende ◽  
...  
Keyword(s):  
Burn Injury ◽  
Continuous Venovenous Hemofiltration ◽  
Burn Patients ◽  
Small Reduction ◽  
Target Attainment ◽  
Clinical Pharmacokinetics ◽  
Once Daily ◽  
Renal Replacement Therapies ◽  
Rapid Clearance ◽  
The Impact

ABSTRACTAmikacin clearance can be increased in burn injury, which is often complicated by renal insufficiency. Little is known about the impact of renal replacement therapies, such as continuous venovenous hemofiltration (CVVH), on amikacin pharmacokinetics. We retrospectively examined the clinical pharmacokinetics, bacteriology, and clinical outcomes of 60 burn patients given 15 mg/kg of body weight of amikacin in single daily doses. Twelve were treated with concurrent CVVH therapy, and 48 were not. The pharmacodynamic target of ≥10 for the maximum concentration of drug in serum divided by the MIC (Cmax/MIC) was achieved in only 8.5% of patients, with a small reduction ofCmaxin patients receiving CVVH and no difference in amikacin clearance. Mortality and burn size were greater in patients who received CVVH. Overall, 172 Gram-negative isolates were recovered from the blood cultures of 39 patients, with amikacin MIC data available for 82 isolates from 24 patients. A 10,000-patient Monte Carlo simulation was conducted incorporating pharmacokinetic and MIC data from these patients. The cumulative fraction of response (CFR) was similar in CVVH and non-CVVH patients. The CFR rates were not significantly improved by a theoretical 20 mg/kg amikacin dose. Overall, CVVH did not appear to have a major impact on amikacin serum concentrations. The low pharmacodynamic target attainment appears to be primarily due to higher amikacin MICs rather than more rapid clearance of amikacin related to CVVH therapy.

Carbon stocks in Tasmanian soils

Soil Research ◽  
2012 ◽  
Vol 50 (2) ◽  
pp. 83 ◽  
Author(s):  
W. E. Cotching
Keyword(s):  
Management Practices ◽  
Agricultural Soils ◽  
C Sequestration ◽  
Mean Annual Temperature ◽  
Soil C ◽  
C Stocks ◽  
Initial Soil ◽  
If Current ◽  
Intensive Cropping ◽  
The Difference

Soil carbon (C) stocks were calculated for Tasmanian soil orders to 0.3 and 1.0 m depth from existing datasets. Tasmanian soils have C stocks of 49–117 Mg C/ha in the upper 0.3 m, with Ferrosols having the largest soil C stocks. Mean soil C stocks in agricultural soils were significantly lower under intensive cropping than under irrigated pasture. The range in soil C within soil orders indicates that it is critical to determine initial soil C stocks at individual sites and farms for C accounting and trading purposes, because the initial soil C content will determine if current or changed management practices are likely to result in soil C sequestration or emission. The distribution of C within the profile was significantly different between agricultural and forested land, with agricultural soils having two-thirds of their soil C in the upper 0.3 m, compared with half for forested soils. The difference in this proportion between agricultural and forested land was largest in Dermosols (0.72 v. 0.47). The total amount of soil C in a soil to 1.0 m depth may not change with a change in land use, but the distribution can and any change in soil C deeper in the profile might affect how soil C can be managed for sequestration. Tasmanian soil C stocks are significantly greater than those in mainland states of Australia, reflecting the lower mean annual temperature and higher precipitation in Tasmania, which result in less oxidation of soil organic matter.

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