scholarly journals Advantages of immediate excision of burn eschar

2020 ◽  
Vol 48 (2) ◽  
pp. 89-92
Author(s):  
John E Greenwood
Keyword(s):  
Gold Standard ◽  
Burn Injury ◽  
Smoke Inhalation ◽  
Survival Outcomes ◽  
Post Injury ◽  
Burn Care ◽  
Major Burn ◽  
The Hours

Early excision of deep burn eschar and the expeditious closure of the resultant wounds have become established as gold standard burn care. However, early burn excision has been accepted as up to four days post injury based on a series of misconceptions, not least that the patient is too unwell to undergo surgery and tolerate anaesthesia too soon after injury. There are several reasons why immediate burn excision yields superior survival outcomes, and these are expounded in this article. The systemic pathophysiology following major burn injury, especially when complicated by the respiratory pathophysiology accompanying smoke inhalation, evolves. The hours immediately after burn injury offer several windows of surgical opportunity, windows closed by the pathophysiological events that peak 24 hours later and make surgery and anaesthesia at that time both dangerous and ill-advised.

Low-dose versus high-dose heparinization during arteriovenous carbon dioxide removal

Perfusion ◽  
2001 ◽  
Vol 16 (6) ◽  
pp. 460-468 ◽  
Author(s):  
J A Murphy ◽  
C M Savage ◽  
S K Alpard ◽  
D J Deyo ◽  
J B Jayroe ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Low Dose ◽  
Burn Injury ◽  
Degradation Products ◽  
Randomized Study ◽  
Carbon Dioxide Removal ◽  
Smoke Inhalation ◽  
High Dose ◽  
Post Injury ◽  
Fibrin Degradation Products

The purpose of this study was to compare low-dose (LD) and high-dose (HD) systemic heparinization in a prospective randomized study of arteriovenous carbon dioxide removal (AVCO2R) during acute respiratory distress syndrome, using a commercially available heparin-coated oxygenator. Adult sheep ( n = 13) received an LD50 smoke inhalation and 40% TBSA third degree cutaneous flame burn injury. At 40-48 h post-injury, animals underwent cannulation of the carotid artery and jugular vein and were then randomized to HD heparin (activated clotting time, ACT > 300 s, n = 6) and LD heparin (ACT > 200 s, n = 7) and placed on AVCO2R for approximately 72 h using an oxygenator with the Trillium Bio-Passive Surface™. Mean ACTs were significantly different, as expected (HD: 446 ± 26 s, LD: 213 ± 12 s, p < 0.05). AVCO2R shunt flow averaged approximately 13% of cardiac output with mean CO2 removal similar in HD and LD, p = NS. The hematocrit, platelet count, and fibrin degradation products for the two groups were not different. No differences in thrombosis or bleeding were noted. In conclusion, LD systemic heparin (ACT < 200 s) with a heparin-coated oxygenator does not increase thrombogenicity during AVCO2R for smoke/burn-induced severe lung injury in sheep.

scholarly journals A Review of Burn Patients Requiring Extracorporeal Membrane Oxygenation at a Burns Facility

2021 ◽  
Vol 2 (4) ◽  
pp. 293-300
Author(s):  
Stephen Frost ◽  
Liz Davies ◽  
Claire Porter ◽  
Avinash Deodhar ◽  
Reena Agarwal
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Burn Injury ◽  
Burn Injuries ◽  
Burn Patients ◽  
Review Of The Literature ◽  
Respiratory Compromise ◽  
Burn Care ◽  
Membrane Oxygenation ◽  
Regular Time ◽  
Major Burn

Respiratory compromise is a recognised sequelae of major burn injuries, and in rare instances requires extracorporeal membrane oxygenation (ECMO). Over a ten-year period, our hospital trust, an ECMO centre and burns facility, had five major burn patients requiring ECMO, whose burn injuries would normally be managed at trusts with higher levels of burn care. Three patients (60%) survived to hospital discharge, one (20%) died at our trust, and one patient died after repatriation. All patients required regular, time-intensive dressing changes from our specialist nursing team, beyond their regular duties. This review presents these patients, as well as a review of the literature on the use of ECMO in burn injury patients. A formal review of the overlap between the networks that cater to ECMO and burn patients is recommended.

Life After Burn Injury: Striving for Regained Freedom

2008 ◽  
Vol 18 (12) ◽  
pp. 1621-1630 ◽  
Author(s):  
Asgjerd Litleré Moi ◽  
Eva Gjengedal
Keyword(s):  
Life Stories ◽  
Burn Injury ◽  
Personal Goals ◽  
Extreme Situation ◽  
Meaningful Life ◽  
Burn Care ◽  
Major Burn ◽  
Significant Effort ◽  
Optimal Quality

Focusing beyond survival, the priority of modern burn care is optimal quality of life. Our aim with this study, which was informed by phenomenology, was to describe and identify invariant meanings in the experience of life after major burn injury. Fourteen adults having sustained a major burn were interviewed, on average, 14 months postinjury, and asked about their experience of important aspects of life. The accident meant facing an extreme situation that demanded vigilance, appropriate action, and the need for assistance. The aftermath of the burn injury and treatment included having to put significant effort into creating coherence in their disrupted personal life stories. Continuing life meant accepting the unchangeable, including going through recurrent processes of enduring, grief, fatalism, comparisons with others, and new feelings of gratefulness. Furthermore, a continuous struggle to change what was changeable, to achieve personal goals, independence, relationships with others, and a meaningful life, were all efforts to regain freedom, aiming for a life as it was before—and sometimes even better.

511 Point-of-care 3-dimensional Body Mapping for Determining Total Body Surface Area in Severely Burned Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S92-S93
Author(s):  
Julia Loegering ◽  
Kevin Webb ◽  
Jesse Ahlquist ◽  
Kevin Krause ◽  
Karen Xu ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Gold Standard ◽  
Burn Injury ◽  
Point Of Care ◽  
Total Body Surface Area ◽  
Body Mapping ◽  
Burn Care ◽  
Total Body

Abstract Introduction With severe burn injury, there is systemic fluid loss due to inflammatory responses in damaged tissue, leading to disruption of cellular processes. Patient fluid levels are restored with the calculation of total body surface area (TBSA). Clinically used TBSA equations are often outdated and inaccurate with error up to 20%, resulting in misinformed treatment and subsequent sequelae including prolonged hospital length of stay and increased mortality. Our objective, therefore, was to create a point-of-care (POC) system employing 3D imaging technology to accurately calculate TBSA for all patient population varieties. Methods Our team employed an iPad attachable, infrared scanner to create 3D models of the human body. From these models, TBSA can be extrapolated using scan processing software. Subject scans were collected on our device and on a gold standard scanner for comparison of TBSA output. Clinical testing on burn patients is occurring at present to establish scanning precision of TBSA in the burn care environment. Results Non-clinical verification tests of the 3D scanned TBSA revealed a 4.05% error when compared to the gold standard, and precision error of 3.8%. Additionally, we introduced the device into the burn unit for preliminary testing with a physician user and non-patient subjects. The subjects were scanned in a prone position to mimic burn care workflow. Clinician scanning error was 1.41% when compared to the gold standard scan of the same subject. Clinical precision study results are on-going in collection. Conclusions Our device introduces an improved method of TBSA estimation to assist clinicians in making accurate burn care decisions and further precision medicine with greater anthropomteric data, notably for children. This device is one of the first POC-3D scanning technologies to be used in a burn setting and may also be employed at outlying medical facilities. Destructive wildfires and combat burn injuries highlight the need for such a device to standardize the triage of burn victims with and away from experienced medical staff. Applicability of Research to Practice 3D body mapping points to an enhanced method of TBSA calculation and minimally disruptive to the burn workflow. Future developments of 3D scanning include deep learning algorithms to identify and better assess burned surface area. Additionally, further automation of TBSA scan processing to reduce user error in calculation and improve burn injury outcomes.

Relation Between Low Pulmonary Function and Skeletal Muscle Index in Burn Patients with Major Burn Injury and Smoke Inhalation: A Retrospective Study

2020 ◽  
Vol 41 (3) ◽  
pp. 695-699 ◽  
Author(s):  
Yu Hui Won ◽  
Yoon Soo Cho ◽  
Dong Hyun Kim ◽  
So Young Joo ◽  
Cheong Hoon Seo
Keyword(s):  
Skeletal Muscle ◽  
Pulmonary Function ◽  
Respiratory Muscle ◽  
Burn Injury ◽  
Pulmonary Function Tests ◽  
Smoke Inhalation ◽  
Burn Patients ◽  
Respiratory Muscle Strength ◽  
Skeletal Muscle Index ◽  
Major Burn

Abstract This report is to evaluate the relation between pulmonary function, respiratory muscle strength, and skeletal muscle index (SMI) in patients with major burn injury and smoke inhalation. A total of 54 inhalation burn patients were analyzed. Appendicular skeletal muscle mass (ASM) is a sum of the muscle mass of both arms and legs. SMI is adjusting for body size using body mass index (ASM/BMI). Spirometry was performed to evaluate pulmonary function. Pulmonary function tests included peak cough flow (PCF), forced vital capacity (FVC), 1-s forced expiratory volume (FEV1), forced expiratory flow rate between 25 and 75% of the FVC (FEF 25–75), FEV1/FVC ratio expressed as a percentage (FEV1/FVC %), peak expiratory flow (PEF), and maximum voluntary ventilation. Expiratory and inspiratory muscle strengths were measured. The relations between pulmonary function, respiratory muscle strength, and SMI were investigated. SMI showed significant correlations with PCF (r = 0.34 and P = 0.02), FVC (r = 0.55 and P &lt; 0.001), FEV1 (r = 0.45 and P = 0.001), and PEF (r = 0.35 and P = 0.01). In multiple regression analysis including age, TBSA, duration of mechanical ventilation, and postburn days studied, SMI was significantly related to FVC, PCF, FEV1, FEV1/FVC, and PEF (P &lt; 0.001, P = 0.02, P = 0.001, P = 0.04, and P = 0.03). Pulmonary function tests are significantly related to SMI in patients with major burn injury and smoke inhalation. Intensive treatment on muscle wasting in patients with burn injury has been proven to be important for improving pulmonary functions.

Respiratory characteristics in patients with major burn injury and smoke inhalation

2021 ◽  
Author(s):  
Yu Hui Won ◽  
Yoon Soo Cho ◽  
So Young Joo ◽  
Cheong Hoon Seo
Keyword(s):  
Muscle Strength ◽  
Pulmonary Function ◽  
Respiratory Muscle ◽  
Burn Injury ◽  
Smoke Inhalation ◽  
Respiratory Muscle Strength ◽  
Expiratory Muscle ◽  
Major Burn ◽  
Inhalation Burn ◽  
Diaphragmatic Movement

Abstract This study aimed to evaluate pulmonary function measurements and respiratory muscle parameters in patients with major burn injury and smoke inhalation. The inclusion criteria included patients who were diagnosed with a smoke inhalation burn or a major burn of more than 20% of total body surface area (TBSA). All subjects underwent a pulmonary function test, respiratory muscle strength test, peak cough flow and fluoroscopic diaphragmatic movement measurement, and six-minute walk test before starting pulmonary rehabilitation. Evaluations were conducted on the 88 th days after the injury, the average time of admission to the Department of the Rehabilitation Medicine for burn rehabilitation after the completion of the acute treatment. The average degree of burns of the total 67 patients was 34.6% TBSA. All parameters in the patient group were significantly lower than the healthy controls, and a mild restrictive pattern of impairment with a reduction in diffusing capacity and more reduced expiratory muscle, than inspiratory muscle strength were observed. Peak cough flow, respiratory muscle strength, and forced vital capacity in the patient group with inhalation burn were significantly lower than in those without inhalation burn. The conditions of the majority of patients with major burn and inhalation injury were consistent with restrictive impairment and significant reduction in diffusion capacity. The patients had expiratory muscle weakness, decreased diaphragmatic movement, and exercise capacity impairment.

Delayed onset pulmonary edema following toxic smoke inhalation; a systematic review

2018 ◽  
Vol 17 (4) ◽  
pp. 203-211
Author(s):  
Daniel M. Björkbom ◽  
◽  
Mikkel Brabrand ◽  
Keyword(s):  
Pulmonary Edema ◽  
Burn Injury ◽  
De Novo ◽  
Inhalation Injury ◽  
Smoke Inhalation ◽  
Cochrane Library ◽  
Post Injury ◽  
Delayed Onset ◽  
Wide Range ◽  
Fire Smoke

Background: Fire smoke inhalation cause a wide range of symptoms immediately or after a relatively asymptomatic period. In this review, we will focus on delayed onset pulmonary edema (DOPE); the incidence and duration of potential delay. As the symptoms may not present immediately, seemingly healthy patients could be inadvertently be sent home. Therefore, many authors recommend observation for 6-24 hours depending on the extent of inhalation injury. Methods: A systematic literature search in Embase, Medline, and Cochrane library was performed on 14 April 2016. All studies describing smoke exposure and delayed pulmonary edema were included. Additional relevant studies were identified snowballing based on included studies. Results: We included seven studies, with a total of 135 patients, describing pulmonary edema. Symptoms generally developed after a relatively asymptomatic period (up to 36 hours post-injury) until mechanical ventilation was needed. However, pulmonary edema developing after 36 hours was most likely due to other factors related to burn injury (excessive intravenous fluids, de novo heart failure, infection or problems related to intubation). Conclusion: Delayed onset pulmonary edema can develop as late as 36 hours postinjury after a relatively uneventful phase. But it would have been rare to have been completely asymptomatic before developing pulmonary edema.

scholarly journals Microbiome in the setting of burn patients: implications for infections and clinical outcomes

2020 ◽  
Vol 8 ◽  
Author(s):  
Silvia Corcione ◽  
Tommaso Lupia ◽  
Francesco G De Rosa ◽  
Keyword(s):  
Burn Injury ◽  
Central Venous Access ◽  
Late Phase ◽  
Subsequent Development ◽  
Venous Access ◽  
Inhalation Injury ◽  
Resistant Bacteria ◽  
Burn Patients ◽  
Burn Care ◽  
Major Burn

Abstract Burn damage can lead to a state of immune dysregulation that facilitates the development of infections in patients. The most deleterious impact of this dysfunction is the loss of the skin’s natural protective barrier. Furthermore, the risk of infection is exacerbated by protracted hospitalization, urinary catheters, endotracheal intubation, inhalation injury, arterial lines and central venous access, among other mainstays of burn care. Currently, infections comprise the leading cause of mortality after major burn injuries, which highlights the improvements observed over the last 50 years in the care provided to burn victims. The need to implement the empirical selection of antibiotic therapy to treat multidrug-resistant bacteria may concomitantly lead to an overall pervasiveness of difficult-to-treat pathogens in burn centres, as well as the propagation of antimicrobial resistance and the ultimate dysregulation of a healthy microbiome. While preliminary studies are examining the variability and evolution of human and mice microbiota, both during the early and late phase burn injury, one must consider that abnormal microbiome conditions could influence the systemic inflammatory response. A better understanding of the changes in the post-burn microbiome might be useful to interpret the provenance and subsequent development of infections, as well as to come up with inferences on the prognosis of burn patients. This review aims to summarise the current findings describing the microbiological changes in different organs and systems of burn patients and how these alterations affect the risks of infections, complications, and, ultimately, healing.

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