scholarly journals Тhe use of corticosteroids in patients with severe burn injuries

2020 ◽  
Keyword(s):  
Burn Injury ◽  
Burn Shock ◽  
Burn Patients ◽  
Severe Burn ◽  
Septic Complications ◽  
Results Of Treatment ◽  
Adults And Children ◽  
Severe Burn Injuries ◽  
Burn Disease ◽  
Severe Burn Injury

Modern treatment of burns has led to a significant reduction in mortality in patients with burns whose injuries were fatal several years ago. However, along with improved survival, new problems arose in the treatment of burn patients. Systemic inflammatory response, capillary leak, sepsis top the list of the most common problems in both adults and children with severe thermal injury. Currently, new strategies are being developed and studied in the treatment of this category of patients. One of the ways to improve the results of treatment of patients with severe burn injury is to prescribe corticosteroids, both in the stage of burn shock and in the development of septic complications. Do corticosteroids reduce mortality and improve recovery in burn patients? The discussion about this has been going on for many years, but the opinion about their effectiveness remains controversial. An analysis of the literature shows that corticosteroids can play a significant role in the treatment of patients with severe burn injury and can be successfully used at any stage of a burn disease. The effect of reducing capillary leakage, increasing myocardial contractility, antiemetic, membrane-stabilizing effect of corticosteroids will be useful in the stage of burn shock. The anti-inflammatory, immunomodulatory effect of corticosteroids will play a role in any stage of a burn disease. With the aim of preventing and treating sepsis, corticosteroids may be useful in the stage of toxemia, septicotoxemia. It is also necessary to remember about adrenal insufficiency, which develops in burn patients. The article analyzes the literature, substantiates the use of corticosteroids in patients with severe burn injury in different periods of a burn disease.

Acute kidney injury in patients with severe burn injury

2018 ◽  
Author(s):  
Nele Brusselaers ◽  
Eric A. J. Hoste
Keyword(s):  
Acute Kidney Injury ◽  
Burn Injury ◽  
Negative Impact ◽  
Kidney Injury ◽  
Severe Form ◽  
Burn Shock ◽  
Burn Patients ◽  
Severe Burn ◽  
Abdominal Hypertension ◽  
Severe Burn Injury

Acute kidney injury (AKI) occurs in approximately one-quarter of all patients with severe burn injury (as defined by the RIFLE consensus classification), and approximately 3% of paediatric burn patients. Overall, a three- to six-fold higher mortality for burn patients with AKI is observed, depending on the applied definition. When AKI is defined by the sensitive RIFLE classification, median mortality of AKI is approximately 35%. This chapter describes the general pathophysiology of AKI in burns, particularly the severe form of burn shock, and discusses in addition the roles of intra-abdominal hypertension, rhabdomyolysis, and the potentially negative impact of povidone-iodine burn dressing. Finally the definitions used in burn pathology, the prevention of AKI with a discussion of the fluid therapy in burned patients, and the role of renal replacement therapy in these patients is discussed.

scholarly journals Sodium variability is associated with increased mortality in severe burn injury

2017 ◽  
Vol 5 ◽  
Author(s):  
Soman Sen ◽  
Nam Tran ◽  
Brian Chan ◽  
Tina L. Palmieri ◽  
David G. Greenhalgh ◽  
...  
Keyword(s):  
Serum Sodium ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Multivariate Logistic Regression Analysis ◽  
Median Number ◽  
High Plasma ◽  
Plasma Sodium ◽  
Burn Patients ◽  
Severe Burn ◽  
Severe Burn Injury

Abstract Background Dysnatremias are associated with increased mortality in critically ill patients. Hypernatremia in burn patients is also associated with poor survival. Based on these findings, we hypothesized that high plasma sodium variability is a marker for increased mortality in severely burn-injured patients. Methods We performed a retrospective review of adult burn patients with a burn injury of 15% total body surface area (TBSA) or greater from 2010 to 2014. All patients included in the study had at least three serum sodium levels checked during admission. We used multivariate logistic regression analysis to determine if hypernatremia, hyponatremia, or sodium variability independently increased the odds ratio (OR) for death. Results Two hundred twelve patients met entry criteria. Mean age and %TBSA for the study was 45 ± 18 years and 32 ± 19%. Twenty-nine patients died for a mortality rate of 14%. Serum sodium was measured 10,310 times overall. The median number of serum sodium measurements per patient was 22. Non-survivors were older (59 ± 19 vs. 42 ± 16 years) and suffered from a more severe burn injury (50 ± 25% vs. 29 ± 16%TBSA). While mean sodium was significantly higher for non-survivors (138 ± 3 milliequivalents/liter (meq/l)) than for survivors (135 ± 2 meq/l), mean sodium levels remained within the laboratory reference range (135 to 145 meq/l) for both groups. Non-survivors had a significantly higher median number of hypernatremic (> 145 meq/l) measurements (2 vs. 0). Coefficient of variation (CV) was significantly higher in non-survivors (2.85 ± 1.1) than survivors (2.0 ± 0.7). Adjusting for TBSA, age, ventilator days, and intensive care unit (ICU) stay, a higher CV of sodium measurements was associated with mortality (OR 5.8 (95% confidence interval (CI) 1.5 to 22)). Additionally, large variation in sodium ranges in the first 10 days of admission may be associated with increased mortality (OR 1.35 (95% CI 1.06 to1.7)). Conclusions Increased variability in plasma sodium may be associated with death in severely burned patients.

scholarly journals INSULIN AND CERTAIN STEROIDS SECRETION IN PATIENTSWITH VARYING SEVERITY OF BURN DISEASE

2014 ◽  
Vol 6 (4) ◽  
pp. 26-31 ◽  
Author(s):  
M I Pugachev ◽  
L M Dobrovolskaya ◽  
V V Ivanov ◽  
S B Shustov
Keyword(s):  
Insulin Resistance ◽  
Burn Injury ◽  
Burn Injuries ◽  
Cortisol Secretion ◽  
Severe Burn ◽  
Testosterone Secretion ◽  
Burn Disease ◽  
Severe Burn Injury

The results levels of insulin, testosterone and cortisol in patients with burn disease are presented. The analysis of the secretion hormones in groups with varying severity of the injury are provided. It was shown that in male burned patients was accompanied with prolonged decrease in testosterone secretion. Degree of inhibition testosterone secretion depends on the severity of burn injuries. Also there were revealed that burn disease was accompanied with prolonged increase in cortisol secretion. It was shown that increase IRI-activity on the 6 th and 14 th day of hospitalization, which may indicate emerging insulin resistance in this period disease. Severe burn injury were observed to hormonal failure, which may reduce the chances of survival of the injured.

scholarly journals DISORDERS OF THE BRAIN IN PATIENTS WITH SEVERE BURN INJURY

2020 ◽  
Vol 21 (3) ◽  
pp. 48-53
Author(s):  
O. V. Orlova ◽  
L. P. Pivovarova ◽  
I. V. Osipova ◽  
O. B. Ariskina
Keyword(s):  
Glasgow Coma Scale ◽  
Neurological Deficit ◽  
Burn Injury ◽  
Blood Levels ◽  
Severe Burn ◽  
Level Of Consciousness ◽  
Burn Disease ◽  
Protein S100b ◽  
The Brain ◽  
Severe Burn Injury

Conducted an assessment of the level of consciousness on the Glasgow coma scale, sedation level on the Richmond scale of excitation and sedation, assessment on the ICDSC and CAM–ICU scales, as well as monitoring the blood levels of protein S100b, NSE, BNP, NT‑proBNP, procalcitonin, interleukins‑6, - 8 in 53 patients with burn disease to determine the timing and criteria for the development of cerebral insufficiency. It was determined that cerebral disorders develop already upon admission and persist up to 20 days of observation. The debut of early sepsis is associated with clinical and laboratory criteria for neurological deficit.

scholarly journals Severe burn injury in late pregnancy: a case report and literature review

2015 ◽  
Vol 3 ◽  
pp. 1-4 ◽  
Author(s):  
Yan Shi ◽  
Xiong Zhang ◽  
Bo-Gao Huang ◽  
Wen-Kui Wang ◽  
Yan Liu
Keyword(s):  
Burn Injury ◽  
Late Pregnancy ◽  
Clinical Problem ◽  
Burn Injuries ◽  
Burn Patients ◽  
Severe Burn ◽  
Burn Center ◽  
Maternal Survival ◽  
Low Incidence ◽  
Severe Burn Injury

Abstract The management of serious burn injuries during pregnancy is an unsolved clinical problem because of the low incidence of this disease. Although it has been documented that the effect of burns on fetal and maternal survival is detrimental, there have been conflicting reports among the different burn centers regarding the mortality of burned pregnant women and the management of burn patients during pregnancy. We report a case of severe burn in late pregnancy treated at our burn center. Additionally, we searched and summarized the literature concerning the management of pregnant patients to provide useful information for their treatment.

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.

OUR EXPERIENCE IN TREATMENT OF PATIENTS WITH THERMO-INHALATION TRAUMA

2020 ◽  
Vol 2 (1) ◽  
pp. 53-58
Author(s):  
Ishnazar Mustafakulov ◽  
◽  
Komil Tagaev ◽  
Khushvaqt Umedov
Keyword(s):  
Intensive Care ◽  
Respiratory Tract ◽  
Thermal Injury ◽  
Burn Injury ◽  
Objective Assessment ◽  
Pulmonary Complications ◽  
Severe Burn ◽  
Clear Tendency ◽  
Burn Disease ◽  
Severe Burn Injury

According to the literature, a combination of skin burns with respiratory tract lesions occurs in 30% of patients with flame burns and there is a clear tendency to its growth. An analysis was made of 205 patients with thermo-inhalation lesions who were treated from 2009 to 2019. Studies have shown that all patients with severe burn injury flame have shown emergency fibrobronchoscopy at the earliest possible date. Timely objective assessment of the severity of TIT and the possibility of developing tracheobronchial and pulmonary complications is an important component in the diagnosis and treatment of patients with thermal injury, and helps to predict the course of burn disease and prescribe adequate intensive care

scholarly journals Allogeneic mesenchymal stem cells for treatment of severe burn injury

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Marc G. Jeschke ◽  
Sarah Rehou ◽  
Matthew R. McCann ◽  
Shahriar Shahrokhi
Keyword(s):  
Stem Cells ◽  
Wound Healing ◽  
Mesenchymal Stem Cells ◽  
Burn Injury ◽  
Severe Burn ◽  
Allogeneic Mscs ◽  
Burn Care ◽  
Severe Burn Injuries ◽  
Severe Burn Injury

AbstractThe most important determinant of survival post-burn injury is wound healing. For decades, allogeneic mesenchymal stem cells (MSCs) have been suggested as a potential treatment for severe burn injuries. This report describes a patient with a severe burn injury whose wounds did not heal with over 18 months of conventional burn care. When treated with allogeneic MSCs, wound healing accelerated with no adverse treatment complications. Wound sites showed no evidence of keloids or hypertrophic formation during a 6-year follow-up period. This therapeutic use of allogeneic MSCs for large non-healing burn wounds was deemed safe and effective and has great treatment potential.

scholarly journals Intestinal barrier dysfunction in severe burn injury

2019 ◽  
Vol 7 ◽  
Author(s):  
Wen He ◽  
Yu Wang ◽  
Pei Wang ◽  
Fengjun Wang
Keyword(s):  
Burn Injury ◽  
Current Knowledge ◽  
Intestinal Barrier ◽  
Multiple Organ ◽  
Intestinal Lumen ◽  
Burn Shock ◽  
Severe Burn ◽  
Barrier Dysfunction ◽  
Intestinal Barrier Dysfunction ◽  
Severe Burn Injury

Abstract Severe burn injury is often accompanied by intestinal barrier dysfunction, which is closely associated with post-burn shock, bacterial translocation, systemic inflammatory response syndrome, hypercatabolism, sepsis, multiple organ dysfunction syndrome, and other complications. The intestinal epithelium forms a physical barrier that separates the intestinal lumen from the internal milieu, in which the tight junction plays a principal role. It has been well documented that after severe burn injury, many factors such as stress, ischemia/hypoxia, proinflammatory cytokines, and endotoxins can induce intestinal barrier dysfunction via multiple signaling pathways. Recent advances have provided new insights into the mechanisms and the therapeutic strategies of intestinal epithelial barrier dysfunction associated with severe burn injury. In this review, we will describe the current knowledge of the mechanisms involved in intestinal barrier dysfunction in response to severe burn injury and the emerging therapies for treating intestinal barrier dysfunction following severe burn injury.

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