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.

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.

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.

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 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).

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.

Prevalence of Psychiatric Disorders in Burn Patients in a Tertiary Care Hospital

2021 ◽  
Vol 15 (11) ◽  
pp. 3389-3391
Author(s):  
Imran Khan ◽  
Taimur Khan ◽  
Shakil Asif ◽  
Syed Azhar Ali Kazmi ◽  
Subhan Ullah ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Care Hospital ◽  
Burn Patients ◽  
Total Body

Background and Aim: Burn injuries patients generally suffer from various psychological and mental disorders especially in lower socio-economic groups. It can adversely affect their wellbeing and health. Proper consultation and clinical diagnosis need to be carried out on burns injuries patients from the early critical phase to rehabilitation phase recovery. The current study's aim was to determine the prevalence of psychiatric disorders in burn patients in a tertiary care hospital. Materials and Methods: This cross-sectional study was conducted on 82 attempted burn suicides, adult patients in Khattak Medical Center Peshawar, Khyber Teaching Hospital Peshawar and Divisional Headquarter hospital, Mirpur AJK for duration of six months from June 2020 to December 2020. All the patients admitted with suicides burns were of either gender and had ages above 15 years. The convenience technique was used for sampling. The patients’ demographic details such as psychiatric illness, self-immolation act motivation, burn injury depth, burn total body surface area, inhalation injury, hospitalization duration, and mortality was recorded on pre-designed proforma. Data analysis was carried out with SPSS version 20. Results: The mean age of all 82 patients was 28.9±5.2 with an age range of 14 to 55 years. Of the total, 66 (80.5%) were female while 16 (19.5%) were male. In this study, the most frequent suicidal attempt was made by the marital conflicted patients 50 (61%) followed by love affair failure 8 (9.7%). An overall mean of 53.6±19.6 was observed for total body surface area affected with a range of 15-100%. The hospital duration mean was 8.2±5.9 with a range of 1-38 days. Young, married, and rural area illiterate housewives were the most common self-inflicted/suicide burn injuries. The prime cause of such injuries was getting married. The mortality rate was found at 82.3%. Conclusion: Our study concluded that patient’s well-being and mental health could be severely affected by burn injuries. Prevalent depression was noted among severe burn injuries patients. Depression related to deformity could be prevented with early grafting, wound management, proper splinting, coping ability, intense physiotherapy, and long-term rehabilitation. Keywords: Burn; Depressed mood, Psychiatric morbidity, Posttraumatic stress disorder

564 Managing California’s Creek Fire Mass Casualty’s Incident

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S132-S132
Author(s):  
Shana M Henry ◽  
Nicole M Kopari ◽  
Mary Wolfe
Keyword(s):  
Operating Room ◽  
Disaster Response ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Rescue Operation ◽  
Burn Victims ◽  
Burn Center ◽  
Response Planning ◽  
Response Team ◽  
Total Body

Abstract Introduction California’s Creek Fire is not only the largest single wildfire in a state known for huge and destructive blazes, it spawned two rare fire tornados with winds over 100mph, a day after the fire started in early September. Huntington Lake and Mammoth Pool were the sites of these rare events leading to hundreds of trapped campers. An air rescue operation airlifted hundreds of trapped people to safety. Twenty days after the start of the fire, it had burned >300,000 acres with only 36% containment by fire crews. This review is an evaluation of our hospitals response team and the events surrounding that night. Methods Our on-call surgeon had called in the back-up surgeon to run a second trauma operating room. It was at this time, the news had reported trapped campers near Mammoth Pool. The burn surgeon was notified and reported to the emergency department (ED) as word of 65 possible victims spread. Local disaster response planning was initiated with an ED physician triaging patients at the regional airport. Initial calls were made to the division chief and burn medical director. The nursing director was notified along with any available nursing staff with 8 ICU nurses volunteering to report. Immediately, lateral transfer orders were placed for all burn patients housed in the burn center which has 10 ICU bed capabilities. Results The first helicopter landed with 5 of the burn victims presenting to our hospital. 4 of the victims were male and 1 female with ages ranging from 17 to 27. Total body surface area burn was estimated on each with 2 minor burns < 10% and 3 moderate sized burns of roughly 25%. These patients were quickly triaged in the ED and traumatic injuries evaluated. 3 of the patients were placed in ICU level care with the 2 remaining patients housed in the ED as word trickled in about another rescue effort with an additional 95 people. By morning, an additional 2 patients were transferred to our burn center from the surrounding hospitals and another 2 patients evaluated for burns sustained in separate events. All patients were taken to the operating room over the next 24–48 hours for excision and autologous spray on skin cells (ASCS) in combination with widely meshed skin grafts or ASCS alone. Conclusions Communication, teamwork, and personnel that are dedicated to the care of burn patients made this tragic incident manageable. The Creek Fire hit home for many of the burn staff not only because of the patients that were cared for, but because this area of California was a beloved respite for many. A debriefing with a chaplain, grief counselor, and psychotherapist, was held within 2 weeks of the incident to provide support to the staff during this devastating time.

524 Effectiveness of Burns Wound Cleansing by Comparison of Prewash and Post Wash Swab Reports

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M A Sayed ◽  
S Jabeen ◽  
A Soueid
Keyword(s):  
Bacterial Load ◽  
Total Body Surface Area ◽  
Wound Management ◽  
Burn Patients ◽  
Burn Wound ◽  
Staph Aureus ◽  
Sex Type ◽  
Total Body ◽  
Burns Unit ◽  
Type Of Injury

Abstract Aim The main aim and objective were to optimise wound healing through infection prevention. This clinical audit aimed to investigate the effectiveness of burn wound cleansing in decreasing bacterial load by comparing pre-wash and post-wash swab results against local burn wound management and aseptic non touch technique (ANTT) guidelines. Method The audit was conducted retrospectively on children admitted to Burns Unit during August 2019, excluding resuscitation burn patients. Pre- and post-wash swabs taken on admission were included and the results obtained from Chameleon database. Data were collected on excel spread sheets including demographic variables such as age, sex, type of injury, percentage total body surface area (TBSA) and mechanism of injury. Data were analysed and results compiled. Results Fifty patients were admitted over a month period; amongst those 60% were male and 40% female of ages ranging from 5 months to 14 years. Scald (50%) was found to be the most common mode of injury followed by contact burn (36%) involving 0.30 to 9% TBSA. Among 50 patients, 30 (60%) showed no growth in pre-wash and 36 (72%) in post-wash swabs. However, 6% post-wash swabs that were initially negative later showed bacillus cereus, staph aureus, Enterobacter, and Acinetobacter. Similarly, another 4% post-wash swabs developed new microorganisms as compared to pre-wash swabs. Conclusions The most common bacteria colonising both pre- and post-wash swabs was staph aureus. Overall, cleansing had reduced the bacterial load significantly around 82% very effective. It is imperative to stick to local guidelines to reduce morbidity and mortality in burn patients.

scholarly journals 653. Diagnosis of Burn Sepsis Using the FcMBL ELISA: A Pilot Study in Critically Ill Burn Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S300-S300 ◽  
Author(s):  
Kevin S Akers ◽  
Taylor Schlotman ◽  
Lee C Mangum ◽  
Gerardo Garcia ◽  
Amanda Wagner ◽  
...  
Keyword(s):  
Dynamic Range ◽  
Total Body Surface Area ◽  
Healthy Controls ◽  
Burn Patients ◽  
Burn Survivors ◽  
Mannose Binding ◽  
Antimicrobial Management ◽  
Fungal Organisms ◽  
Total Body ◽  
Molecular Patterns

Abstract Background Infection is the leading cause of death among burn survivors, with sepsis associated with more extensive burns. Conventional diagnostic criteria are insensitive in this population. We examined a novel diagnostic ELISA based on Mannose-Binding Lectin (MBL) linked to an immunoglobulin Fc domain, which measures the concentration of Pathogen-Associated Molecular Patterns (PAMPs) across a broad range of bacterial and fungal organisms, for diagnosis and antimicrobial management of sepsis in burn patients. Methods We prospectively enrolled burn patients with ≥15% Total Body Surface Area (TBSA) burns into groups of noninfected, sepsis, or incipient infection, and healthy volunteers. Sepsis was defined by clinical actions responsive to sepsis. The FcMBL ELISA was performed daily using fresh whole blood. Burn subjects were sampled daily until completing antimicrobials, for 14 days if noninfected, and once for healthy controls. Differences in median PAMP concentrations between groups were assessed with the Kruskal–Wallis test, including multiple comparisons between categories. Results 14 burn patients (3 noninfected, of whom 1 died prior to sampling, 4 Sepsis, 7 Incipient) were enrolled. The median (25–75% CI) PAMP concentration was 0.53 (0.12–1.34) ng/mL in healthy controls, 3.725 (2.53–5.94) ng/mL in noninfected, 2.22 (1.42–4.62) ng/mL in incipient, and 1.59 (0.83–2.29) ng/mL in sepsis groups. PAMP concentrations in sepsis were different (P = 0.0057) from noninfected, but incipient did not differ from noninfected (P = 0.2025). The dynamic range was lower in healthy controls (2.69 ng/mL) than incipient (4.57 ng/mL), sepsis (4.70 ng/mL), or noninfected (5.90 ng/mL). PAMP elevations correlated with clinical deterioration from infection, and were not associated with OR visits for debridement and grafting. 7 of 11 infected patients had declining PAMP levels at completion of antimicrobial therapy. 2 subjects had PAMP elevations associated with Aspergillus molds in their burn wounds. Conclusion The FcMBL ELISA assay may be useful for diagnosis of infection in burn patients, and may facilitate earlier discontinuation of antimicrobials. This assay may also have a novel utility for early diagnosis of Invasive Fungal Infection. Disclosures All authors: No reported disclosures.

scholarly journals Multimodal Analgesia and Discharge Opioid Requirements in Burn Patients

2020 ◽  
Vol 41 (5) ◽  
pp. 963-966
Author(s):  
Michael Wright ◽  
Jin A Lee
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Multimodal Analgesia ◽  
Burn Patients ◽  
Area Burned ◽  
Total Body ◽  
The Impact

Abstract Analgesia in burn patients is challenging given the complexity of burn pain and prolonged need beyond hospital admission. Given the risks of opioids, the impact of multimodal analgesia postdischarge needs to be further elucidated in this population. This retrospective, single-center cohort study evaluated adult burn patients who were consecutively admitted to the burn service with at least 10% total body surface area burned and subsequently followed in the burn clinic between February 2015 and September 2018. Subjects were separated into two cohorts based on discharge pain regimens: multimodal and nonmultimodal. The primary outcome was the change in opioid requirements (measured in oral morphine equivalents) between discharge and first follow-up interval. Secondary outcomes included the classes of multimodal agents utilized and a comparison of opioid requirements between the last 24 hours of admission and discharge. A total of 152 patients were included for analysis, 76 in the multimodal cohort and 76 in the nonmultimodal cohort. The multimodal cohort was noted to have increased total body surface area burned and prolonged number of days spent in the intensive care unit at baseline; however, the multimodal cohort exhibited a more significant decrease in opioid requirements from discharge to first follow-up interval when compared with the nonmultimodal cohort (106.6 vs 75.4 mg, P = .039).

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