Pathogenic Characteristics and Risk Factors for ESKAPE Pathogens Infection in Burn Patients

Abstract BackgroundAfter clinical evaluation in the emergency department (ED), facial burn patients are usually intubated to protect their airways. However, the possibility of unnecessary intubation or delayed intubation after admission exists. Objective criteria for the evaluation of inhalation injury and the need for airway protection in facial burn patients are needed.MethodsFacial burn patients between January 2013 and May 2016 were reviewed. Patients who were and were not intubated in the ED were compared. All intubated patients received routine bronchoscopy to evaluate whether they had inhalation injuries. Patients with and without confirmed inhalation injuries were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for inhalation injuries in facial burn patients. The reasons for intubation in patients without inhalation injuries were also investigated.ResultsDuring the study period, 121 patients were intubated in the ED among a total of 335 facial burn patients. Only 73 (60.3%) patients were later confirmed to have inhalation injuries on bronchoscopy. The comparison between patients with and without inhalation injuries showed that shortness of breath (odds ratio=3.376, p=0.027) and high total body surface area (TBSA) (odds ratio=1.038, p=0.001) were independent risk factors for inhalation injury. Other physical signs (e.g., hoarseness, burned nostril hair, etc.), laboratory examinations and chest X-ray findings were not predictive of inhalation injury in facial burn patients. All patients with a TBSA over 60% were intubated in the ED even if they did not have inhalation injuries.ConclusionIn the management of facial burn patients, positive signs on conventional physical examinations may not always be predictive of inhalation injury and the need for endotracheal tube intubation in the ED. More attention should be paid to facial burn patients with shortness of breath and a high TBSA because they have an increased risk of inhalation injuries. Airway protection is needed in facial burn patients without inhalation injuries because of their associated injuries and treatment.

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Clinical Risk Factors Associated with Mortality Among Burn Patients Admitted to Jinnah Burn and Reconstructive Surgery Center, Lahore

Proceedings of Shaikh Zayed Medical Complex Lahore - October to December ◽

10.47489/p000s343z7611-5mc ◽

2020 ◽

Vol 34 (3) ◽

pp. 46-50

Author(s):

Fatima Sakhawat

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Reconstructive Surgery ◽

Low Income ◽

Burn Injuries ◽

Clinical Risk Factors ◽

Burn Patients ◽

Factors Associated ◽

Clinical Risk ◽

Surgery Center

Introduction: Burn injuries being highly devastating in nature, are associated with extensive morbidity and mortality. Although the incidence of burn injuries is less in developed countries but it is increasing in developing and low income countries. Aims & Objectives: The aim of this study was to determine clinical risk factors associated with mortality among burn patients. Place and duration of study: Jinnah Burn and Reconstructive Surgery Center, Lahore from August 2018 till January 2019. Material & Methods: Data was collected by researchers themselves by studying files of patients. Data analysis was done by using SPSS and Pearson Chi Square test was used to determine association of clinical risk factors with mortality among burn patients. Results: Out of 200 patients, 137 were males. The Mortality rate was 12.50 %. Cardiopulmonary arrest was the most common cause of death. Sepsis was the most common complication among burn patients. Higher mortality rates were observed among patients with arterial/venous and urinary catheterization done. Higher survival rates were seen in those patients who were treated with debridement, grafting surgeries, Colistin Use and aided by mechanical ventilation. Conclusion: Aid through mechanical ventilation, grafting surgeries, wound debridement, use of colistin are associated with improved survival outcomes among burn patients. Whereas inhalational injury, arterial/venous catheterization, urinary catheter and sepsis are seen as major predictors of mortality among burn patients

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Risk Factors for Fungal Colonisation and Infection in Burn Patients

Journal of Burn Care & Research ◽

10.1097/01253092-200603001-00165 ◽

2006 ◽

Vol 27 (Supplement) ◽

pp. S131

Author(s):

D Bracco ◽

M Dubois ◽

P Deroy ◽

N Morrissette ◽

E Sirdar ◽

...

Keyword(s):

Risk Factors ◽

Burn Patients ◽

Fungal Colonisation

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26 Clogged Feeding Tubes: Why Does It Matter?

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.031 ◽

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

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.280 ◽

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.

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