703 Evaluating the Risk Factors and the Time-course of High Intraocular Pressures in Severely Burned Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S182-S183
Author(s):  
Lucy Wibbenmeyer ◽  
Anthony P Mai ◽  
Erin M Shriver ◽  
Christopher Fortenbach ◽  
Kai Wang
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Vision Loss ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Inclusion Criteria ◽  
Post Injury ◽  
Calculated Volume ◽  
Total Body ◽  
Parkland Formula

Abstract Introduction Severely burned patients are at risk for high intraocular pressures (IOP) and permanent vision loss from orbital compartment syndrome (OCS). Identification of at-risk patients for timely intervention is critical. This study aims to identify OCS risk factors and determine IOP trends to guide optimum monitoring in burn patients. Methods Medical records of burn patients seen by the ophthalmology service between 2004 and 2019 were reviewed. Patients undergoing resuscitation were split into those with high IOPs (PHigh IOP; ≥ 26 mmHg) and those with normal IOPs (PControl; IOPs ≤ 25 mmHg). Additional analysis to determine the timing of IOP elevations was performed on 13 patients (6 from the resuscitation group and 7 with facial burns). Results 33 of the 430 patients reviewed met inclusion criteria. Twenty-six patients underwent resuscitation, 6 of whom had elevated IOPs. Analysis of the PHigh IOP (n = 6) and PControl (n = 20) groups showed that elevated IOPs were associated with larger total body surface area (TBSA) burned (p = 0.002), a higher likelihood of exceeding the IVY index (> 250 ml/kg) (p = 0.018), and higher Parkland Formula calculated volume (p < 0.001). Maximum IOP and actual fluid resuscitation volume were linearly related (p < 0.001). Analysis of all patients with elevated IOP showed increases of 0.5 to 7 mmHg/hour with a highest absolute rise of 31 mmHg over 12 hours. All elevations occurred within 24 hours post injury. 8 patients had OCS, 2 of whom were not resuscitated due to small TBSA burns.33 of the 430 patients reviewed met inclusion criteria. Twenty-six patients underwent resuscitation, 6 of whom had elevated IOPs. Analysis of the PHigh IOP (n = 6) and PControl (n = 20) groups showed that elevated IOPs were associated with larger total body surface area (TBSA) burned (p = 0.002), a higher likelihood of exceeding the IVY index (> 250 ml/kg) (p = 0.018), and higher Parkland Formula calculated volume (p < 0.001). Maximum IOP and actual fluid resuscitation volume were linearly related (p < 0.001). Analysis of all patients with elevated IOP showed increases of 0.5 to 7 mmHg/hour with a highest absolute rise of 31 mmHg over 12 hours. All elevations occurred within 24 hours post injury. 8 patients had OCS, 2 of whom were not resuscitated due to small TBSA burns. Conclusions While large TBSA burns, exceeding the Ivy Index, and Parkland Formula calculated volume are potential OCS risk factors in burn patients, 25% of the patients who developed OCS had facial burns and did not require resuscitation. Earlier involvement of ophthalmology and more frequent IOP checks in susceptible burn patients will help identify those most at risk for OCS and vision loss. Applicability of Research to Practice Both the characteristics and the timing of increased intraocular patients is critical to ensuring prompt involvement of the ophthalmology team and treatment of the eye to preserve vision.

Preserving Vision: Rethinking Burn Patient Monitoring to Prevent Orbital Compartment Syndrome

2020 ◽  
Vol 41 (5) ◽  
pp. 1104-1110
Author(s):  
Anthony P Mai ◽  
Christopher R Fortenbach ◽  
Lucy A Wibbenmeyer ◽  
Kai Wang ◽  
Erin M Shriver
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Compartment Syndrome ◽  
Fluid Resuscitation ◽  
Vision Loss ◽  
Total Body Surface Area ◽  
Treatment Center ◽  
Burn Patients ◽  
Calculated Volume ◽  
Parkland Formula

Abstract Burn patients receiving aggressive fluid resuscitation are at risk of developing orbital compartment syndrome (OCS). This condition results in elevated orbital pressures and can lead to rapid permanent vision loss. Risk factors and monitoring frequency for OCS remain largely unknown. A retrospective review was therefore conducted of admitted burn patients evaluated by the ophthalmology service at an American Burn Association verified Burn Treatment Center. Demographic, burn, examination, and fluid resuscitation data were compared using two-sided t-tests, Fisher’s exact tests, and linear regression. Risk factors for elevated intraocular pressures (IOPs; a surrogate for intraorbital pressure) in patients resuscitated via the Parkland formula were found to be total body surface area (% TBSA) burned, resuscitation above the Ivy Index (>250 ml/kg), and Parkland formula calculated volume. Maximum IOP and actual fluid resuscitation volume were linearly related. Analysis of all patients with elevated IOP found multiple patients with significant IOP increases after initial evaluation resulting in OCS within the first 24 hours postinjury. While %TBSA, Ivy Index, and resuscitation calculated volume are OCS risk factors in burn patients, two patients with facial burns developed OCS (25% of all patients with OCS) despite not requiring resuscitation. Orbital congestion can develop within the first 24 hours of admission when resuscitation volumes are the greatest. In addition to earlier and more frequent IOP checks in susceptible burn patients during the first day, the associated risk factors will help identify those most at risk for OCS and vision loss.

85 Safety and Efficacy of Early Fresh Frozen Plasma Administration in Burn Resuscitation

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S55-S56 ◽  
Author(s):  
Arek J Wiktor ◽  
Heather Carmichael ◽  
Elizabeth B Weber ◽  
Patrick Duffy ◽  
Anne L Lambert Wagner
Keyword(s):  
Total Body Surface Area ◽  
Fresh Frozen Plasma ◽  
Future Research ◽  
Burn Patients ◽  
Post Injury ◽  
Fresh Frozen ◽  
Total Body ◽  
Abdominal Compartment ◽  
Burn Resuscitation ◽  
Frozen Plasma

Abstract Introduction Controversy exists over the use of colloid required for burn resuscitation. Data show that fresh frozen plasma (FFP) may have benefits beyond volume sparing alone, however, there are inherent risks including transfusion related acute lung injury (TRALI) and transfusion reactions (TR). The aims of this project were: (1) determine the effectiveness of early FFP during burn resuscitation, and (2) to document any potential side effects of FFP administration. Methods A retrospective review was performed on all burn patients aged >18 years old with >20% total body surface area (TBSA) burns who underwent resuscitation using our nursing guided resuscitation protocol (NGRP) from November 2016- June 2019 at our ABA- verified burn center. Excluded were those with electrical injury, delayed resuscitation, polytrauma, renal replacement therapy and or death within 24 hours (hrs) of injury. Pursuant to the NGRP all patients with >30% TBSA burns received FFP at 6–8 hrs post injury. Data recorded included: demographics, % TBSA burned, total crystalloid/FFP, and urine output (UO). An hourly resuscitation ratio (I/O ratio) of fluid given (ml/kg/%TBSA/hr) to UO (ml/kg/hr) was calculated. FFP initiation was standardized to time zero. Major complications such as abdominal compartment syndrome (ACS), acute respiratory distress syndrome (ARDS), TRALI and TR were documented. Univariate statistical analysis was performed. Results Over the study period 71 patients required NGRP resuscitation, 56 met inclusion criteria. Baseline demographics included: 47 male (84%), median age 34 years [IQR 27–53], median TBSA 30% [range 20–95%]. 40 patients were resuscitated with FFP versus 16 patients resuscitated with crystalloid alone. Median time to FFP administration was 7 hours [IQR 6–8] with an average of 1866 ml infused [779–4484]. Those who received FFP had larger % TBSA burns median 41% [29–57] vs no FFP 22% [20–24], p< 0.001. Median I/O ratio at FFP initiation improved from 1.0 [IQR 0.4–3.7] to 0.4 [IQR 0.2–1.5, p=0.01] at 2 hrs post FFP, see Graph. Median UOP improved from 0.18 cc/kg/hr the 2 hrs prior to FFP administration, to 0.44 cc/kg/hr at 2 hrs post FFP (p=0.01). Total 24 hour fluids given (cc/kg/% TBSA) were similar in both groups: FFP 3.94 [3.49–5.36] vs no FFP 3.92 [3.54–4.53], p=0.77. There were no reported incidents of ACS, ARDS, TRALI, or TR. Conclusions The use of FFP in burn resuscitation significantly improves UOP and normalizes I/O ratios. FFP administration did not cause any serious complications. Applicability of Research to Practice Future research efforts should focus on comparing albumin vs FFP in acute burn resuscitation.

707 Factors Associated with Early vs. Late AKI in Burn Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S184-S185
Author(s):  
Jessicah A Respicio ◽  
Patrick Duffy ◽  
Tyler M Smith ◽  
Kiran U Dyamenahalli ◽  
Arek J Wiktor ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Late Onset ◽  
Total Body Surface Area ◽  
Kidney Injury ◽  
Primary Objective ◽  
Morbidity And Mortality ◽  
Burn Patients ◽  
Post Injury ◽  
Factors Associated ◽  
Total Body

Abstract Introduction Acute kidney injury (AKI) in burn patients is known to increase morbidity and mortality, with significant improvement after the initiation of renal replacement therapy (RRT). Our primary objective is to characterize the sub-population of burn patients with early (≤48 hours post-injury) versus late (>48 hours post injury) onset of AKI. We hypothesize that patients with early onset AKI versus late onset AKI have different causalities, risk factors, and outcomes. A secondary aim is to investigate the timing and use of RRT in the setting of early and late AKI with the goal of improving morbidity and mortality. Methods A retrospective cohort study was conducted on all patients admitted to a verified burn center requiring RRT for AKI from 2015 – 2019. Patients were stratified by age, gender, percent total body surface area (TBSA), race, time of onset of AKI, timing of RRT initiation, hospital LOS, pre-admission co-morbidities, admission toxicology, and mortality. Results In total, 1537 burn patients were reviewed and 1.3% (n=20) required RRT for AKI. Out of this cohort, 70% developed early AKI and 30% developed late AKI. Early versus late AKI patients had the same median age (57). Patients with larger TBSA developed early AKI (median TBSA 51%) versus late AKI (median TBSA 21%). Half of the patients who developed late AKI presented with positive alcohol toxicology screens, while 86% of patients with early AKI tested negative. The patient mortality rate in early AKI was 57%, and the mortality rate in late AKI was 17%. Only 14% of early AKI patients required dialysis at discharge, while 33% of late AKI patients required dialysis at discharge. The majority of patients started on early RRT (< 48 hours post injury) did not develop sepsis (43% developed sepsis), while the majority of patients started on late RRT (>48 hours post injury) did develop sepsis (85%). Conclusions Positivity for alcohol on admission may be a predictor for development of late AKI, while larger TBSA may predict early AKI. Mortality is higher for patients with early AKI; however, the need for dialysis at discharge is higher in patients with late AKI. Our data further suggests that early initiation of RRT is negatively correlated with the development of sepsis. Applicability of Research to Practice A deeper understanding of associations and causality of early vs late onset AKI in burn patients will help guide further management and improve outcomes.

scholarly journals Epidemiology of Scars and Their Consequences: Burn Scars

2020 ◽  
pp. 37-43
Author(s):  
Margriet E. van Baar
Keyword(s):  
Risk Factors ◽  
Burn Injury ◽  
Healing Process ◽  
Total Body Surface Area ◽  
Female Gender ◽  
Burn Injuries ◽  
Post Injury ◽  
The People ◽  
Total Body ◽  
Burn Depth

AbstractPathological scarring in burn wounds can result in hypertrophic scars and/or contractures. Prevalences of hypertrophic scarring after burn injuries between 8% and 67% are reported. A recent prospective study revealed a prevalence of 8%. Data on prevalence of burn scar contractures are limited; reported prevalence at discharge varied between 38 and 54% and decreased with an increasing time post burn. About 5–20% of the people who suffered from burn injuries received reconstructive surgery after burns, up to 10 years post injury.Factors predicting pathological scar formation after burn injuries include patient, injury and treatment characteristics. Injury- and treatment-related characteristics are the main predictors of scar outcomes after burn injury. These characteristics are related to burn size (total body surface area burned) and burn depth (number or type of surgery) or the overall healing process in general (length of stay, wound healing complications). Intrinsic patient-related risk factors seem to play a role as well but are less consistent predictors of scar outcome. This includes the risk factors like the female gender and also a younger age and darker skin.Knowledge on risk factors for poor scar outcome can be used to tailor treatment, aftercare and scar prevention to these patients with a high-risk profile.

Burn-Center Quality Improvement: Are Burn Outcomes Dependent on Admitting Facilities and is There a Volume-Outcome “Sweet-Spot”?

2012 ◽  
Vol 78 (5) ◽  
pp. 559-566 ◽  
Author(s):  
Tjasa Hranjec ◽  
Florence E. Turrentine ◽  
George Stukenborg ◽  
Jeffrey S. Young ◽  
Robert G. Sawyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Body Surface Area ◽  
Significant Risk ◽  
Inhalation Injury ◽  
P Value ◽  
Burn Patients ◽  
Multivariable Logistic Regression Model ◽  
Risk Of Mortality ◽  
Volume Outcome ◽  
Total Body

Risk factors of mortality in burn patients such as inhalation injury, patient age, and percent of total body surface area (%TBSA) burned have been identified in previous publications. However, little is known about the variability of mortality outcomes between burn centers and whether the admitting facilities or facility volumes can be recognized as predictors of mortality. De-identified data from 87,665 acute burn observations obtained from the National Burn Repository between 2003 and 2007 were used to estimate a multivariable logistic regression model that could predict patient mortality with reference to the admitting burn facility/facility volume, adjusted for differences in age, inhalation injury, %TBSA burned, and an additional factor, percent full thickness burn (%FTB). As previously reported, all three covariates (%TBSA burned, inhalation injury, and age) were found to be highly statistically significant risk factors of mortality in burn patients (P value < 0.0001). The additional variable, %FTB, was also found to be a statistically significant determinant, although it did not greatly improve the multivariable model. The treatment/admitting facility was found to be an independent mortality predictor, with certain hospitals having increased odds of death and others showing a protective effect (decreased odds ratio). Hospitals with high burn volumes had the highest risk of mortality. Mortality outcomes of patients with similar risk factors (%TBSA burned, inhalation injury, age, and %FTB) are significantly affected by the treating facility and their admission volumes.

Nebulized Heparin With N-Acetylcysteine and Albuterol Reduces Duration of Mechanical Ventilation in Patients With Inhalation Injury

2017 ◽  
Vol 32 (2) ◽  
pp. 163-166 ◽  
Author(s):  
Kaitlin A. McGinn ◽  
Katie Weigartz ◽  
Alicia Lintner ◽  
Michael J. Scalese ◽  
Steven A. Kahn
Keyword(s):  
Mechanical Ventilation ◽  
Unit Length ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Inclusion Criteria ◽  
Mechanically Ventilated ◽  
Total Body ◽  
Injury Outcomes ◽  
The Impact

Objective: Nebulized heparin has been proposed to improve pulmonary function in patients with inhalation injuries. The purpose of this study was to evaluate the impact of nebulized heparin with N-acetylcysteine (NAC) and albuterol on the duration of mechanical ventilation in burn patients. Methods: This is a retrospective study evaluating mechanically ventilated adult patients admitted to a regional burn center with inhalation injury. Outcomes were compared between patients who were prescribed a combination of nebulized heparin with NAC and albuterol versus similar patients who did not. Results: A total of 48 patients met inclusion criteria (heparin n = 22; nonheparin n = 26). Patients in the nonheparin group had higher percentage of total body surface area (TBSA) burned (29.00 [5.75-51.88] vs 5.25 [0.50-13.25] %TBSA; P = .009), longer duration of mechanical ventilation (6.50 [2.75-17.00] vs 3.00 [1.00-8.25] days; P = .022), and longer intensive care unit length of stay (LOS) (3.00 [3.00-28.75] vs 5.50 days [2.00-11.25]; P = .033). Upon regression, use of heparin was the only variable associated with reducing the duration of mechanical ventilation ( P = .039). Conclusion: Nebulized heparin in combination with NAC and albuterol was associated with a significant reduction in the duration of mechanical ventilation.

5 -Year Retrospective Analysis of a Vented Mobility Algorithm in the Burn ICU

2022 ◽  
Author(s):  
Audrey Marie O'Neil ◽  
Cassandra Rush ◽  
Laura Griffard ◽  
David Roggy ◽  
Allison Boyd ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Recent Literature ◽  
Total Body Surface Area ◽  
Early Mobilization ◽  
Burn Patients ◽  
Mechanically Ventilated ◽  
Line Placement ◽  
Total Body ◽  
Stage 1 ◽  
Significant Attention

Abstract Early mobilization with mechanically ventilated patients has received significant attention within recent literature, however limited research has focused specifically on the burn population. The purpose of this single center, retrospective analysis was to review the use of a burn critical care mobility algorithm, to determine safety and feasibility of a burn vented mobility program, share limitations preventing mobility progression at our facility, and discuss unique challenges to vented mobility with intubated burn patients. A retrospective review was completed for all intubated burn center admissions between January 2015 to December 2019. Burn Therapy notes were then reviewed for data collection, during the intubation period, using stages of the mobility algorithm. In 5 years following initial implementation, the vented mobility algorithm was utilized on 127 patients with an average total body surface area of 22.8%. No adverse events occurred. Stage 1 (Range of motion) was completed with 100% of patients (n=127). Chair mode of bed, stage 2a, was utilized in 39.4%(n=50) of patients, while 15.8% (n=20) of patients were dependently transferred to the cardiac chair in stage 2b. Stage 3 (sitting on the edge-of-bed) was completed with 25% (n=32) of patients, with 11% (n=14) progressing to stage 5 (standing), and 3.9% (n=5) actively transferring to a chair. In 5 years, only 4.7% (n=6) reached stage 6 (ambulation). The most common treatment limitations were medical complications (33%) and line placement (21%). Early mobilization during mechanical ventilation is safe and feasible within the burn population, despite challenges including airway stability, sedation, and line limitations.

scholarly journals Invasive Candidiasis in Hospitalized Patients with Major Burns

2022 ◽  
Vol 12 (1) ◽  
pp. 47
Author(s):  
Yi-Ling Lin ◽  
I-Chen Chen ◽  
Jung-Hsing Yen ◽  
Chih-Sheng Lai ◽  
Yueh-Chi Tsai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Invasive Candidiasis ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Total Body Surface Area ◽  
Reference Value ◽  
Hospitalized Patients ◽  
Research Database ◽  
Specific Population ◽  
Total Body

Background: Invasive candidiasis (IC) is a major cause of morbidities and mortality in patients hospitalized with major burns. This study investigated the incidence of IC in this specific population and analyzed the possible risk factors. Materials and Methods: We retrospectively analyzed data from the National Health Insurance Research Database (NHIRD) of Taiwan. We identified 3582 patients hospitalized with major burns on over 20% of their total body surface area (TBSA) during 2000–2013; we further analyzed possible risk factors. Result: IC was diagnosed in 452 hospitalized patients (12.6%) with major burns. In the multivariate analysis, patients older than 50 years (adjusted odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.36–2.82), those of female sex (adjusted OR = 1.33, 95% CI 1.03–1.72), those with burns on the head (adjusted OR = 1.33, 95% CI 1.02–1.73), and those with burns over a greater TBSA had higher risks of IC. Conclusion: Treating IC is crucial in healthcare for major burns. Our study suggests that several risk factors are associated with IC in patients hospitalized with major burns, providing reliable reference value for clinical decisions.

scholarly journals A Comparative Study between C-Reactive Protein and Procalcitonin in Iraqi Burn Patients

2017 ◽  
Vol 28 (1) ◽  
pp. 41
Author(s):  
Alia E. Al-Ubadi
Keyword(s):  
Burn Injury ◽  
Total Body Surface Area ◽  
Latex Agglutination ◽  
Burn Patients ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Survivor Group ◽  
Significant Difference ◽  
The Mean ◽  
Total Body

Association between Procalcitonin (PCT) and C-reactive protein (CRP) and burn injury was evaluated in 80 burned patients from Al-Kindy and Imam Ali hospitals in Baghdad-Iraq. Patients were divided into two groups, survivor group 56 (70%) and non-survivor group 24 (30%). PCT was estimated using (Human Procalcitonin ELISA kit) provided by RayBio/USA while CRP was performed using a latex agglutination kit from Chromatest (Spain). Our results declared that the mean of Total Body Surface Area (TBSA %) affected were 63.5% range (36%–95%) in non-survivor patients, while 26.5% range (10%–70%) in survivor patients. There is a significant difference between the two groups (P = 0.00), the higher mean percentage of TBSA has a significant association with mortality. Serum PCT and CRP were measured at the three times of sampling (within the first 48hr following admission, after 5thdays and after 10th days). The mean of PCT serum concentrations in non-survivor group (2638 ± 3013pg/ml) were higher than that of survivor group (588 ± 364pg/ml). Significantly high levels of CRP were found between the survivor and non-survivor groups especially in the 10th day of admission P=0.000, present study show that significant differences is found within the non-survivor group through the three times P= 0.01, while results were near to significant differences within survivor group through the three times (P= 0.05).

26 Clogged Feeding Tubes: Why Does It Matter?

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S22-S23
Author(s):  
Sarah Zavala ◽  
Ashley Wang ◽  
Cheryl W Zhang ◽  
Jennifer M Larson ◽  
Yuk Ming Liu
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Nutritional Support ◽  
Total Body Surface Area ◽  
Tube Feeding ◽  
Feeding Tube ◽  
Admission Diagnosis ◽  
Burn Patients ◽  
Feeding Tubes ◽  
Burn Unit

Abstract Introduction Many patients treated on a burn unit require tube feeding as their primary caloric source or as supplemental feeding due to their injuries. Burn patients specifically require higher caloric intake due to the hypermetabolic state of burn injuries. Inadequate nutritional support contributes to longer ICU stays and higher mortality. Clogged feeding tubes reduce nutrition provided due to temporary discontinuation of feeding. The objective of this study was to identify risk factors for the incidence of tube clogging. Methods This was a single-center retrospective chart review of all patients admitted to an American Burn Association-verified Burn Unit between August 2017 and October 2019 who received tube feeds during their admission. Data collected included baseline demographics, clinical outcomes, and details about tube feed formulations, number of clogs, and details leading up to the clog. Baseline demographics were compared using descriptive statistics. Nominal data was compared using Chi-square test. Continuous data was analyzed using student’s t-test or Mann-Whitney U test. Results A total of 170 patients were included; admission diagnoses included burn (97), soft tissue infections (29), SJS/TEN (11), and others (33). At least one clogged feeding tube was experienced by 51 patients and some experienced up to seven separate clogs. SJS/TEN patients were less likely to experience a clog (9.2 vs 0%, p = 0.035) and frostbite patients were more likely to experience a clog (0 vs 5.9%, p = 0.026). Burn mechanism did not affect incidence of tube feed clog, but patients with larger total body surface area (TBSA) burned were more likely to have a clog (15.55 vs 25.03%, p = 0.004). It was a median of 12 days until the first clog occurred (IQR 7.8–17.3). Two tube feed formulas demonstrated an increased likelihood of clog: a renal formulation (16.8 vs 33.3%, p = 0.017) and a polymeric concentrated product (5.0 vs 17.6%, p = 0.008). Both products have a high viscosity. Patients who experienced a clog had a longer length of stay (21.5 vs 44.0 days, p = 0.001). Conclusions This study identified several risk factors associated with higher incidence of clogged feeding tube in the burn unit including tube feed formulation and viscosity, admission diagnosis, and larger TBSA in burn patients. This study also confirms that clogged feeding tubes, and the resultant insufficient nutritional support, may contribute to an increased length of stay.

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