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.

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.

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.

664 Risk Factors for the Development of Transaminitis in Pediatric Burn Patients Treated with Oxandrolone

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S177-S177
Author(s):  
Kate Pape ◽  
Sarah Zavala ◽  
Rita Gayed ◽  
Melissa Reger ◽  
Kendrea Jones ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Pediatric Patients ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Future Research ◽  
Burn Patients ◽  
Thermal Burn ◽  
Increased Risk ◽  
Significant Difference

Abstract Introduction Oxandrolone is an anabolic steroid that is the standard of care for burn patients experiencing hypermetabolism. Previous studies have demonstrated the benefits of oxandrolone, including increased body mass and improved wound healing. One of the common side effects of oxandrolone is transaminitis, occurring in 5–15% of patients, but little is known about associated risk factors with the development of transaminitis. A recent multicenter study in adults found that younger age and those receiving concurrent intravenous vasopressors or amiodarone were more likely to develop transaminitis while on oxandrolone. The purpose of this study was to determine the incidence and identify risk factors for the development of transaminitis in pediatric burn patients receiving oxandrolone therapy. Methods This was a multicenter, retrospective risk factor analysis that included pediatric patients with thermal burn injury (total body surface area [TBSA] > 10%) who received oxandrolone over a 5-year time period. The primary outcome of the study was the development of transaminitis while on oxandrolone therapy, which was defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >100 mg/dL. Secondary outcomes included mortality, length of stay, and change from baseline ALT/AST. Results A total of 55 pediatric patients from 5 burn centers met inclusion criteria. Of those, 13 (23.6%) developed transaminitis, and the mean time to development of transaminitis was 17 days. Patients who developed transaminitis were older (12 vs 6.4 years, p = 0.01) and had a larger mean %TBSA (45.9 vs 34.1, p = 0.03). The odds of developing transaminitis increased by 23% for each 1 year increase in age (OR 1.23, CI 1.06–1.44). The use of other concurrent medications was not associated with an increased risk of developing transaminitis. Renal function and hepatic function was not associated with the development of transaminitis. There was no significant difference in length of stay and mortality. Conclusions Transaminitis occurred in 23.6% of our study population and was associated with patients who were older and had a larger mean %TBSA burn. Older pediatric patients with larger burns who are receiving oxandrolone should be closely monitored for the development of transaminitis. Applicability of Research to Practice Future research is needed to identify appropriate monitoring and management of transaminitis in oxandrolone-treated pediatric burn patients.

scholarly journals Epidemiological and clinical characteristics of burns in the older person: a seven-year retrospective analysis of 693 cases at a burn center in south-west China

2020 ◽  
Vol 8 ◽  
Author(s):  
Wei Qian ◽  
Song Wang ◽  
Yangping Wang ◽  
Xiaorong Zhang ◽  
Mian Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Anatomical Location ◽  
Burn Patients ◽  
Full Thickness ◽  
Older Individuals ◽  
West China ◽  
South West

Abstract Background Burns are one of the major traumas that may affect older individuals. The purpose of this study was to investigate the epidemiological and clinical characteristics of geriatric burns at a major center in south-west China. Methods This retrospective study was conducted at the Institute of Burn Research, Southwest Hospital of Army Medical University between 2010 and 2016, and the data collected from medical records included admission date, age, gender, premorbid disease, burn etiology, injured anatomical location, burn area and depth, inhalation injury, number of surgeries, length of stay (LOS), clinical outcome, and medical cost. Results Of the 693 older burn patients included, 60.75% were male and 56.85% were aged 60–69 years. Burns peaked in December–March and June. Flame was the most common cause of burns, making up 51.95% of all cases, and also dominated in the burn patients aged 60–69 years. Limbs were the most common anatomical sites of burns (69.41%), and the median total body surface area (TBSA) was 5% (interquartile range [IQR]: 2%–15%). The percentage of the patients who underwent surgeries and number of surgeries significantly increased in the cases of contact burns, younger age and full-thickness burns. Six deaths resulted in a mortality of 0.9%. The median LOS was 16 days (IQR: 8–29 days), and the main risk factors were more surgeries, better outcomes, and full-thickness burns. The median cost was 20,228 CNY (IQR: 10,457– 46,581.5 CNY), and major risk factors included longer LOS, larger TBSA, and more surgeries. Furthermore, compared to the earlier data from our center, the proportion of older adults among all burns (7.50% vs. 4.15%), proportion of flame burns (51.95% vs. 33.90%), and mean age (69.05 years vs. 65.10 years) were significantly higher, while the proportion of premorbidities (16.9% vs. 83.9%), mortality (0.9% vs. 7.5%) and median TBSA (5% vs. 21%) were significantly lower. Conclusions This study suggested that closer attention should be paid to prevent burn injuries in older people aged 60–69 years, especially males, regarding incidents in the summer and winter, and flame burns. Moreover, tailored intervention strategies based on related risk factors should be under special consideration.

scholarly journals Risk Factors for Healthcare-Associated Infections in Adult Burn Patients

2017 ◽  
Vol 38 (12) ◽  
pp. 1441-1448 ◽  
Author(s):  
Paula D. Strassle ◽  
Felicia N. Williams ◽  
David J. Weber ◽  
Emily E. Sickbert-Bennett ◽  
Anne M. Lachiewicz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Burn Injury ◽  
Tertiary Care ◽  
Total Body Surface Area ◽  
Cox Proportional Hazards ◽  
Future Research ◽  
Healthcare Associated Infections ◽  
Burn Patients ◽  
Inhalational Injury ◽  
Healthcare Associated

OBJECTIVEBurn patients are particularly vulnerable to infection, and an estimated half of all burn deaths are due to infections. This study explored risk factors for healthcare-associated infections (HAIs) in adult burn patients.DESIGNRetrospective cohort study.SETTINGTertiary-care burn center.PATIENTSAdults (≥18 years old) admitted with burn injury for at least 2 days between 2004 and 2013.METHODSHAIs were determined in real-time by infection preventionists using Centers for Disease Control and Prevention criteria. Multivariable Cox proportional hazards regression was used to estimate the direct effect of each risk factor on time to HAI, with inverse probability of censor weights to address potentially informative censoring. Effect measure modification by burn size was also assessed.RESULTSOverall, 4,426 patients met inclusion criteria, and 349 (7.9%) patients had at least 1 HAI within 60 days of admission. Compared to <5% total body surface area (TBSA), patients with 5%–10% TBSA were almost 3 times as likely to acquire an HAI (hazard ratio [HR], 2.92; 95% CI, 1.63–5.23); patients with 10%–20% TBSA were >6 times as likely to acquire an HAI (HR, 6.38; 95% CI, 3.64–11.17); and patients with >20% TBSA were >10 times as likely to acquire an HAI (HR, 10.33; 95% CI, 5.74–18.60). Patients with inhalational injury were 1.5 times as likely to acquire an HAI (HR, 1.61; 95% CI, 1.17–2.22). The effect of inhalational injury (P=.09) appeared to be larger among patients with ≤20% TBSA.CONCLUSIONSLarger burns and inhalational injury were associated with increased incidence of HAIs. Future research should use these risk factors to identify potential interventions.Infect Control Hosp Epidemiol 2017;38:1441–1448

scholarly journals Adequate fluid resuscitation decreases incidence of acute renal failure in burn patients

2019 ◽  
Vol 38 (2) ◽  
pp. 108
Author(s):  
Daniel Ardian Soeselo ◽  
Etheldreda Alexandria Stephanie Suparman
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Fluid Resuscitation ◽  
Burn Injury ◽  
Laboratory Data ◽  
Albumin Level ◽  
Burn Patients ◽  
Cross Sectional ◽  
Exact Test ◽  
Parkland Formula

BACKGROUND <br />Burns constitute a severe health problem in many countries. In Indonesia burns rank 4th of all trauma-related diseases and are a burden on the country’s health system. Adequate fluid resuscitation is the initial management of burns that determines the success of treatment. This study aimed to determine the relationship between adequate fluid resuscitation and incidence of acute renal failure in burn patients. <br /><br />METHODS<br />A retrospective study of cross-sectional design was conducted on 30 burn patients who came to the Emergency Unit (ER) from January 2015-December 2017. Medical records were reviewed to examine the data on fluid resuscitation according to the Parkland formula and the laboratory data. Acute renal failure was defined as a creatinine level of more than 2.1 mg/dL after 7 days. Hypoalbuminemia was defined as an albumin level of less than 3.4 g/dL. Fisher’s exact test was used to analyze the data.<br /><br />RESULTS<br />Twenty-two subjects received fluid resuscitation according to the Parkland formula and 8 did not. Twenty-five experienced complications such as acute renal failure (ARF) (13.3%), hypoalbuminemia (46.7%) and a combination of ARF and hypoalbuminemia (23.3%). One person died. Adequate fluid resuscitation was significantly associated with decrease incidence of ARF (p=0.015), but not significantly with hypoalbuminemia (p=0.214) and with mortality (p=0.267).<br /><br />CONCLUSION<br />Adequate fluid resuscitation decreased the incidence of ARF in burn patients. Consensus protocols for initial burn resuscitation and treatment are crucial to avoid the consequences of ARF after burn injury.

scholarly journals ABDOMINAL COMPARTMENT SYNDROME IN BURN PATIENTS

2018 ◽  
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Fluid Resuscitation ◽  
Burn Injury ◽  
Abdominal Pressure ◽  
Burn Patients ◽  
Severe Burn ◽  
Severe Burns ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are consistently associated with morbidity and mortality among the critically ill or injured. Thus, avoiding or potentially treating these conditions may improve patient outcomes. Despite a large number of special publications devoted to this problem, very little attention is paid to the ACS in patients with severe burn injuries. Severe burns have been shown to be a risk factor for developing IAH. Fluid resuscitation practices used in burns management further predispose patients to increase intra-abdominal pressure. The incidence of intraabdominal hypertension in patients with severe thermal injury is, according to different authors, 57.8–82.6 %. The mortality associated with IAH in severe burns is very high once organ dysfunction occurs. The purpose of this work is to collect and analyze the problem of abdominal hypertension in burn patients, as well as to draw conclusions on the prevention of this condition and improve the results of treatment of patients with severe burn injury. Intra-abdominal hypertension is a frequent complication in severe burn patients requiring massive fluid resuscitation. Development of ACS in burn patients is associated with high mortality. Prevention, early detection and proper management may avoid this usually fatal complication. Fluid resuscitation volume is directly responsible for the development of ACS in severe burned patients. Thus, optimal fluid resuscitation can be the best prevention of IAH and ACS.

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