scholarly journals Modeling Fluid Resuscitation by Formulating Infusion Rate and Urine Output in Severe Thermal Burn Adult Patients: A Retrospective Cohort Study

2015 ◽  
Vol 2015 ◽  
pp. 1-8
Author(s):  
Qizhi Luo ◽  
Wei Li ◽  
Xin Zou ◽  
Yongming Dang ◽  
Kaifa Wang ◽  
...  
Keyword(s):  
Fluid Resuscitation ◽  
Urine Output ◽  
Infusion Rate ◽  
Initial Period ◽  
Adult Patients ◽  
Burn Patients ◽  
Severe Burn ◽  
Burn Treatment ◽  
Thermal Burn ◽  
Burn Care

Acute burn injuries are among the most devastating forms of trauma and lead to significant morbidity and mortality. Appropriate fluid resuscitation after severe burn, specifically during the first 48 hours following injury, is considered as the single most important therapeutic intervention in burn treatment. Although many formulas have been developed to estimate the required fluid amount in severe burn patients, many lines of evidence showed that patients still receive far more fluid than formulas recommend. Overresuscitation, which is known as “fluid creep,” has emerged as one of the most important problems during the initial period of burn care. If fluid titration can be personalized and automated during the resuscitation phase, more efficient burn care and outcome will be anticipated. In the present study, a dynamic urine output based infusion rate prediction model was developed and validated during the initial 48 hours in severe thermal burn adult patients. The experimental results demonstrated that the developed dynamic fluid resuscitation model might significantly reduce the total fluid volume by accurately predicting hourly urine output and has the potential to aid fluid administration in severe burn patients.

scholarly journals The Rational of Colloid Requirements in Burn Patients : Literature Reviews

1970 ◽  
Vol 1 (2) ◽  
Author(s):  
Aditya Wardhana ◽  
Shiera Septrisya
Keyword(s):  
Fluid Resuscitation ◽  
Urine Output ◽  
Infusion Rate ◽  
Burn Patients ◽  
Fluid Infusion ◽  
Acceptable Alternative ◽  
Important Principle ◽  
Literature Reviews ◽  
Parkland Formula ◽  
Patient Studies

Backgrounds: For decades, fluid resuscitation in burn patients has been done as a routine process; most clinicians continue to adjust volume requirements using Parkland formula for the initial 24- hour period. In a variety of situations, there is increasing recognition of using significantly greater volumes than anticipated by the Parkland formula; clinicians tend to escalate volume requirements to drive the urine output to the higher end of any desired range. This excessive fluid could result in numerous edema-related complications, which currently coined as “fluid creep” phenomenon. Besides optimizing titration of fluid infusion rate, there have been studies of earlier and more liberal use of colloids, and even the use of hypertonic saline. The overall goal is to reduce the resuscitation volume requirements and subsequently, early edema formation.Conclusion: Current research in fluid resuscitation now concentrates on approaches to minimize fluid creep, including tighter control of fluid infusion rate. The single most important principle in using the Parkland formula, however, is that it should be used only as a guideline. The resuscitation rate and volume must be continually adjusted based on the response of the patient. Studies have been demonstrated to compare the use of crystalloids with early colloid in the first 24 hours post burn. At present, there are still wide variations in the timing of colloid resuscitation. However, use of 5% albumin in the second 24 hours seems to be an acceptable alternative.

scholarly journals Guidelines for burn rehabilitation in China

2015 ◽  
Vol 3 ◽  
pp. 1-10 ◽  
Author(s):  
◽  
Ying Cen ◽  
Jiake Chai ◽  
Huade Chen ◽  
Jian Chen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Burn Injury ◽  
Medical Science ◽  
Current Medical ◽  
Team Work ◽  
Burn Patients ◽  
Burn Treatment ◽  
Burn Care ◽  
Chinese Association

Abstract Quality of life and functional recovery after burn injury is the final goal of burn care, especially as most of burn patients survive the injury due to advanced medical science. However, dysfunction, disfigurement, contractures, psychological problems and other discomforts due to burns and the consequent scars are common, and physical therapy and occupational therapy provide alternative treatments for these problems of burn patients. This guideline, organized by the Chinese Burn Association and Chinese Association of Burn Surgeons aims to emphasize the importance of team work in burn care and provide a brief introduction of the outlines of physical and occupational therapies during burn treatment, which is suitable for the current medical circumstances of China. It can be used as the start of the tools for burn rehabilitation.

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.

scholarly journals A 3-Year Review of an Outpatient Burn Sedation Program in a Tertiary Burn Care Centre: Is It Safe and Does It Work?

2019 ◽  
Vol 27 (4) ◽  
pp. 305-310
Author(s):  
Rayleigh Chan ◽  
Aaron C. Van Slyke ◽  
Marija Bucevska ◽  
Cynthia Verchere
Keyword(s):  
Adverse Events ◽  
Deep Sedation ◽  
Tertiary Care ◽  
Common Mechanism ◽  
Burn Patients ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Burn Treatment ◽  
Burn Care ◽  
Treatment Room

Introduction: The burn treatment room at our tertiary-care centre is run by a multidisciplinary team, providing care to primarily burn patients who require moderate to deep sedation to undergo dressing changes in a monitored setting outside the operating room. There is little literature on the safety, efficacy, and logistics of treating outpatient pediatric burn patients in this manner. This study reviews the safety of deep sedation in the burn treatment room. Methods: A retrospective chart review of patients with burns treated in the burn treatment room from 2013 to 2015 was conducted. Patient demographics, diagnosis, procedure details, sedation, and adverse events were recorded. Data were analyzed descriptively. Results: Sevety-four patients with burns had a total of 308 visits in the burn treatment room for burn bath and/or dressing changes. Scald burns were the most common mechanism of injury (n = 56). Most burns were superficial and mid-dermal (54%), initially estimated at 5% to 10% TBSA (50%). Of the 308 visits, 304 required sedation. Adverse events were recorded in 11 (3.6%) of 304 sedated procedures. None of these events were critical: 7 patients required intravenous conversion due to inadequate oral sedation, 2 experienced brief apnea episodes but recovered spontaneously, and 2 had delayed discharge of more than 2 hours due to residual sedation. Conclusion: The burn treatment room is a safe and effective setting for treating pediatric burn patients, bypassing what might historically require operating suite inpatient management.

126 Early Transcriptomic Response to Burn injury: Prolonged Inflammatory Response is Associated with Mortality

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S85-S86
Author(s):  
John W Keyloun ◽  
Ross Campbell ◽  
Leanne Detwiler ◽  
Stacy-Ann Miller ◽  
Aarti Guatam ◽  
...  
Keyword(s):  
Pathway Analysis ◽  
Cellular Response ◽  
Burn Injury ◽  
High Morbidity ◽  
Burn Patients ◽  
Severe Burn ◽  
Transcriptomic Response ◽  
Burn Care ◽  
Inflammatory Pathways ◽  
Severe Burn Injury

Abstract Introduction Burn injuries are associated with high morbidity and mortality. Burn care has improved significantly in the last few decades with emphasis on early surgical management, improvements in local wound care, and specialized critical care. While survival rates are improving, mortality remains high in certain patient populations, including those with larger burns. Burn injury induces a systemic hyperinflammatory response with detrimental side effects. Prior studies have offered early insights into the biochemical changes that occur after severe burn injury. The underlying cellular response is still largely unknown. The goal of this work is to characterize the blood transcriptome of severe burn injury and compare this response between patients who live or subsequently die of their injuries. Methods Burn patients presenting to a regional center between 2012–2017 were prospectively enrolled. Blood was collected on admission and at predetermined timepoints (Hours 2, 4, 8, 12, 24) over the first 24 hours. mRNA was isolated and a transcriptomic microarray was used to measure global transcript levels over time. To identify differentially regulated genes (FDR≤0.1) by injury severity, patients were grouped by burn size (TBSA >20%) and mortality. Microarray data was analyzed using bioinformatics software and pathway analysis. Descriptive statistics were generated with Mann-Whitney, Chi-Square, and Fisher’s exact test as appropriate. Results Sixty-eight patients were included in this analysis, most patients were male with a median age of 41 (IQR, 30.5–58.5) years, and TBSA of 20% (IQR, 11–34%). Thirty-five patients suffered %TBSA injury >20%, and this group experienced greater mortality (26% vs. 3%, p=0.008). There were no significant differences in age, race, or gender. Comparative analysis of genes from patients with < />20% TBSA revealed 1250, 444, 209, 20, 865, and 557 differentially regulated genes at hours 0, 2, 4, 8, 12 and 24 respectively. Pathway analysis reveals an initial upregulation in several immune/inflammatory pathways within the >20% TBSA groups between hours 0–2 followed by shutdown between hours 12–24. Immune pathways include Th17 activation pathway and natural killer cell signaling, inflammatory pathways include EIF2 signaling. These pathways remain upregulated in the group of patients with >20% TBSA who died. Conclusions Severe burn injury is associated with an early proinflammatory immune response followed by shutdown of these pathways. Burn patients who die show continued upregulation in the first 24 hours after injury in several proinflammatory pathways compared to those who live.

scholarly journals Nurse Staffing, the Clinical Work Environment, and Burn Patient Mortality

2020 ◽  
Vol 41 (4) ◽  
pp. 796-802 ◽  
Author(s):  
Amanda P Bettencourt ◽  
Matthew D McHugh ◽  
Douglas M Sloane ◽  
Linda H Aiken
Keyword(s):  
Work Environment ◽  
Nurse Staffing ◽  
Additional Patient ◽  
Future Research ◽  
Burn Patients ◽  
Thermal Burn ◽  
Cross Sectional ◽  
Burn Care ◽  
Hospital Nursing ◽  
Burn Patient

Abstract The complexity of modern burn care requires an integrated team of specialty providers working together to achieve the best possible outcome for each burn survivor. Nurses are central to many aspects of a burn survivor’s care, including physiologic monitoring, fluid resuscitation, pain management, infection prevention, complex wound care, and rehabilitation. Research suggests that in general, hospital nursing resources, defined as nurse staffing and the quality of the work environment, relate to patient mortality. Still, the relationship between those resources and burn mortality has not been previously examined. This study used a multivariable risk-adjusted regression model and a linked, cross-sectional claims database of more than 14,000 adults (≥18 years) thermal burn patients admitted to 653 hospitals to evaluate these relationships. Hospital nursing resources were independently reported by more than 29,000 bedside nurses working in the study hospitals. In the high burn patient-volume hospitals (≥100/y) that care for the most severe burn injuries, each additional patient added to a nurse’s workload is associated with 30% higher odds of mortality (P < .05, 95% CI: 1.02–1.94), and improving the work environment is associated with 28% lower odds of death (P < .05, 95% CI: 0.07–0.99). Nursing resources are vital in the care of burn patients and are a critical, yet previously omitted, variable in the evaluation of burn outcomes. Attention to nurse staffing and improvement to the nurse work environment is warranted to promote optimal recovery for burn survivors. Given the influence of nursing on mortality, future research evaluating burn patient outcomes should account for nursing resources.

scholarly journals Fluid management in major burn injuries

2010 ◽  
Vol 43 (S 01) ◽  
pp. S29-S36
Author(s):  
Mehmet Haberal ◽  
A. Ebru Sakallioglu Abali ◽  
Hamdi Karakayali
Keyword(s):  
Patient Group ◽  
Fluid Resuscitation ◽  
Fluid Management ◽  
Burn Injuries ◽  
Fluid Loss ◽  
Burn Patients ◽  
Burn Treatment ◽  
Major Burn ◽  
The World ◽  
The Status

ABSTRACTIt is a widely accepted fact that severe fluid loss is the greatest problem faced following major burn injuries. Therefore, effective fluid resuscitation is one of the cornerstones of modern burn treatment. The aim of this article is to review the current approaches available for modern trends in fluid management for major burn patients. As these current approaches are based on various experiences all over the world, the knowledge is essential to improve the status of this patient group.

scholarly journals The Patient’s Perspective: Burn Reconstructive Surgery During the COVID-19 Pandemic

2021 ◽  
Author(s):  
Paul Won ◽  
Karel-Bart Celie ◽  
Violeta Perez ◽  
T Justin Gillenwater ◽  
Haig A Yenikomshian
Keyword(s):  
Reconstructive Surgery ◽  
Burn Patients ◽  
Inclusion Criteria ◽  
Burn Treatment ◽  
Burn Care ◽  
Postoperative Therapy ◽  
Burn Center ◽  
Increased Risk ◽  
Average Patient ◽  
Hospital Systems

Abstract During the Covid-19 pandemic, hospital systems delayed or halted elective surgeries and outpatient care, profoundly disrupting reconstructive burn treatment ranging from surgery to postoperative therapy. This study aims to characterize burn patients’ perspectives on reconstructive surgery during Covid-19. A 12-component questionnaire to burn patients awaiting reconstructive surgery at a single ABA verified Burn Center was administered. Responses regarding willingness to undergo reconstruction, perceived medical and personal impacts of Covid-19, and perspectives on telehealth were gathered. Surveys were administered to patients/caregivers over the phone in English and Spanish. Inclusion criteria consisted of burn patients who had elective reconstructive surgeries delayed or canceled as a result of the pandemic. 51 patients met our inclusion criteria. Of those, 23 patients responded to our survey (45%). Average patient age was 23, 43% were male, and a majority (52%) were pediatric. 22 (96%) patients were willing to undergo reconstruction during the Covid-19 pandemic, despite a perceived increased risk. 43% disagreed or strongly disagreed that telehealth adequately enabled communication with their burn care provider. 78% agreed or strongly agreed that they felt more susceptible to Covid-19 as burn patients. 83% agreed or strongly agreed that the Covid-19 pandemic had created stressors specifically related to their burn care. The majority of patients expressed a strong desire to return to surgical and therapeutic care delayed by Covid-19. Patients reported feeling especially vulnerable to the Covid-19 pandemic as burn patients, and cited difficulty obtaining care and financial stressors as the main causes.

scholarly journals Burns in the elderly: a nationwide study on management and clinical outcomes

2020 ◽  
Vol 8 ◽  
Author(s):  
Harold Goei ◽  
Margriet E van Baar ◽  
Jan Dokter ◽  
J Vloemans ◽  
Gerard I J M Beerthuizen ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Management ◽  
Reference Group ◽  
The Elderly ◽  
Adult Patients ◽  
Burn Patients ◽  
Nationwide Study ◽  
Discharge Disposition ◽  
Burn Care ◽  
Grafting Technique

Abstract Background In modern-day burn care, advanced age remains an important predictor for mortality among burn victims. In this study, we compared the complete treatment trajectory (including pre-hospital and surgical treatment) and the outcomes between an elderly burn population and a younger adult burn population. Methods In this nationwide study, data from the Dutch Burn Repository were used. This is a uniform national registration for Dutch specialized burn care. All adult patients that were admitted to one of the three Dutch burn centres from the period 2009 to 2015 were included in the analysis. Burn patients were considered as elderly when ≥65 years of age, and were then further subdivided into three age categories: 65–74, 75–85 and 85+ years. Younger adults in the age category 18–64 years were used as the reference group. Surgical management was studied comprehensively and included timing of surgery, the number of procedures and details on the surgical technique, especially the technique used for debridement and the grafting technique that was applied. For the comparison of clinical outcome, the following parameters were included: mortality, wound infections, length of stay/TBSA (total body surface area) burned, discharge disposition and secondary reconstructions. Results During the study period, 3155 adult patients were included (elderly, n = 505). Burn severity, reflected by the median TBSA, varied between 3.2–4.0% and was comparable, but aetiology and pre-hospital care were different between elderly and the younger adult reference group. Surgical treatment was initiated significantly faster in elderly burn patients (p < 0.001). Less selective techniques for surgical debridement were used in the elderly burns patients (hydrosurgery, 42.0% vs 23.5–22.6%), and on the other hand more avulsion (5.3% vs 7.3–17.6%) and primary wound closure (6.7% vs 24.5%). The most frequently used grafting technique was meshed skin grafts (79.2–88.6%); this was not related to age. Mortality increased rapidly with a higher age and showed a high peak in the 85+ category (23.8%). Furthermore, considerable differences were found in hospital discharge disposition between the elderly and the reference group. Conclusions In conclusion, elderly burn patients who require specialized burn care are vulnerable and medically challenging. Differences in aetiology, comorbidity, physiology and the management prior to admission possibly affect the initial surgical management and result in significantly worse outcomes in elderly. Elderly patients need optimal, timely and specialized burn care to enhance survival after burn injuries.

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