scholarly journals State of the Art: An Update on Adult Burn Resuscitation

2021 ◽  
Vol 2 (3) ◽  
pp. 152-167
Author(s):  
Jacqueline M. Causbie ◽  
Lauren A. Sattler ◽  
Anthony P. Basel ◽  
Garrett W. Britton ◽  
Leopoldo C. Cancio
Keyword(s):  
Fluid Resuscitation ◽  
Infusion Rate ◽  
Psychosocial Care ◽  
Burn Injuries ◽  
Concomitant Injuries ◽  
Fluid Infusion ◽  
Wound Assessment ◽  
Life Threatening ◽  
Severe Burn Injuries ◽  
Burn Resuscitation

Treatment of patients with severe burn injuries is complex, relying on attentive fluid resuscitation, successful management of concomitant injuries, prompt wound assessment and closure, early rehabilitation, and compassionate psychosocial care. The goal of fluid resuscitation is to maintain organ perfusion at the lowest possible physiologic cost. This requires careful, hourly titration of the infusion rate to meet individual patient needs, and no more; the risks of over-resuscitation, such as compartment syndromes, are numerous and life-threatening. Recognizing runaway resuscitations and understanding how to employ adjuncts to crystalloid resuscitation are paramount to preventing morbidity and mortality. This article provides an update on fluid resuscitation techniques in burn patients, to include choosing the initial fluid infusion rate, using alternate endpoints of resuscitation, and responding to the difficult resuscitation.

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 The effects of a limited infusion rate of fluid in the early resuscitation of sepsis on glycocalyx shedding measured by plasma syndecan-1: a randomized controlled trial

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jutamas Saoraya ◽  
Lipda Wongsamita ◽  
Nattachai Srisawat ◽  
Khrongwong Musikatavorn
Keyword(s):  
Adverse Events ◽  
Organ Failure ◽  
Fluid Resuscitation ◽  
Infusion Rate ◽  
Controlled Trial ◽  
Geometric Mean ◽  
Endothelial Glycocalyx ◽  
Open Label ◽  
Randomized Controlled ◽  
Standard Rate

Abstract Background Aggressive fluid administration is recommended in the resuscitation of septic patients. However, the delivery of a rapid fluid bolus might cause harm by inducing degradation of the endothelial glycocalyx. This research aimed to examine the effects of the limited infusion rate of fluid on glycocalyx shedding as measured by syndecan-1 in patients with sepsis-induced hypoperfusion. Methods A prospective, randomized, controlled, open-label trial was conducted between November 2018 and February 2020 in an urban academic emergency department. Patients with sepsis-induced hypoperfusion, defined as hypotension or hyperlactatemia, were randomized to receive either the standard rate (30 ml/kg/h) or limited rate (10 ml/kg/h) of fluid for the first 30 ml/kg fluid resuscitation. Subsequently, the fluid rate was adjusted according to the physician’s discretion but not more than that of the designated fluid rate for the total of 6 h. The primary outcome was differences in change of syndecan-1 levels at 6 h compared to baseline between standard and limited rate groups. Secondary outcomes included adverse events, organ failure, and 90-day mortality. Results We included 96 patients in the intention-to-treat analysis, with 48 assigned to the standard-rate strategy and 48 to the limited-rate strategy. The median fluid volume in 6 h in the limited-rate group was 39 ml/kg (interquartile range [IQR] 35–52 ml/kg) vs. 53 ml/kg (IQR 46–64 ml/kg) in the standard-rate group (p < 0.001). Patients in the limited-rate group were less likely to received vasopressors (17% vs 42%; p = 0.007) and mechanical ventilation (20% vs 41%; p = 0.049) during the first 6 h. There were no significantly different changes in syndecan-1 levels at 6 h between the two groups (geometric mean ratio [GMR] in the limited-rate group, 0.82; 95% confidence interval [CI], 0.66–1.02; p = 0.07). There were no significant differences in adverse events, organ failure outcomes, or mortality between the two groups. Conclusions In sepsis resuscitation, the limited rate of fluid resuscitation compared to the standard rate did not significantly reduce changes in syndecan-1 at 6 h. Trial registration Thai Clinical Trials Registry number: TCTR20181010001. Registered 8 October 2018, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=4064

Effects of Exercise Training on Fat Mass in Individuals with Severe Burn Injuries

2002 ◽  
Vol 23 ◽  
pp. S77
Author(s):  
O. E. Suman ◽  
R. P. Mlcak ◽  
S. J. Thomas ◽  
D. N. Herndon
Keyword(s):  
Exercise Training ◽  
Fat Mass ◽  
Burn Injuries ◽  
Severe Burn ◽  
Severe Burn Injuries

The rise of factor X level in blood plasma of patients at severe burn injuries

2021 ◽  
Author(s):  
George P Kozynets ◽  
Volodymyr P Tsyhankov ◽  
Daria S Korolova ◽  
Olga V Gornytska ◽  
Olexiy M Savchuk ◽  
...  
Keyword(s):  
Protein C ◽  
Antithrombin Iii ◽  
Burn Injury ◽  
Activated Partial Thromboplastin Time ◽  
Burn Injuries ◽  
Factor X ◽  
Severe Burn ◽  
Clotting Factors ◽  
Thrombotic Complications ◽  
Severe Burn Injuries

Abstract This work is dedicated to the detection of imbalance between the pro- and anti-coagulant branches of hemostasis at severe burn injuries by evaluating the content or activity of individual clotting factors. To select the targets for accurate diagnostics we measured the concentrations of soluble fibrin monomeric complexes and fibrinogen, levels of total prothrombin, factor X, protein C and antithrombin III, and recorded the time of clotting in activated partial thromboplastin time and prothrombin time tests. Factor X level was increased in 26 % of patients on the first day after the burn and it rose further in 62 % patients on the 14 th day of recovery. Increasing factor X level is assumed to be a risk factor of thrombotic complications. We propose to use it as a marker of predisposition to thrombosis at severe burn injury.

Endotoxemia and complement activation after severe burn injuries-effects on leukocytes, soluble selectins, and inflammatory cytokines

Inflammation ◽  
1996 ◽  
Vol 20 (3) ◽  
pp. 229-241 ◽  
Author(s):  
O. Ljunghusen ◽  
J. Lundahl ◽  
H. Nettelblad ◽  
B. Nilsson ◽  
F. Sj�gren ◽  
...  
Keyword(s):  
Inflammatory Cytokines ◽  
Complement Activation ◽  
Burn Injuries ◽  
Severe Burn ◽  
Severe Burn Injuries

scholarly journals Case report of Wolfe grafting for the management of bilateral cicatricial eyelid ectropion following severe burn injuries

2018 ◽  
Vol 34 ◽  
pp. 58-61 ◽  
Author(s):  
Nina Jovanovic ◽  
Admira Dizdarevic ◽  
Nedzad Dizdarevic ◽  
Amir Haracic ◽  
Lamija Gafurovic
Keyword(s):  
Case Report ◽  
Burn Injuries ◽  
Severe Burn ◽  
Severe Burn Injuries

Expansion potential of skin grafts with novel I-shaped auxetic incisions

2021 ◽  
Author(s):  
Vivek Gupta ◽  
Arnab Chanda
Keyword(s):  
Skin Grafting ◽  
Burn Injuries ◽  
Skin Grafts ◽  
Severe Burn ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Shape Pattern ◽  
Severe Burn Injuries ◽  
Poisson's Ratios ◽  
Poisson’S Ratios

Abstract Severe burn injures lead to millions of fatalities every year due to lack of skin replacements. While skin is a very limited and expensive entity, split thickness skin grafting, which involves the projection of a parallel incision pattern on a small section of healthy excised skin, is typically employed to increase the expansion and cover a larger burn site. To date, the real expansion capacity of such grafts are low (<3 times) and insufficient for treatment of severe burn injuries. In this study, novel I-shaped auxetic incision patterns, which are known to exhibit high negative Poisson’s ratios, have been tested on the skin to investigate their expansion potential. Fourteen two-layer skin graft models with varying incision pattern parameters (i.e., length, spacing, and orientation) were developed using finite element modelling and tested under uniaxial and biaxial tensile loads. The Poisson’s ratio, meshing ratios, and induced stresses were quantified across all models. Graft models tested uniaxially along the orthogonal directions indicated opposite trends in generated Poisson’s ratios, as the length of the I-shape incisions were increased. Biaxially, with a symmetric and closely spaced I-shape pattern, graft meshing ratios up to 15.65 were achieved without overstressing the skin. Overall, the findings from the study indicated that expansion potentials much higher than that of traditional skin grafts can be achieved with novel I-shaped auxetic skin grafts, which would be indispensable for covering large wounds in severe burn injuries.

Pharyngeal swallowing elicited by fluid infusion: role of volition and vallecular containment

1996 ◽  
Vol 270 (2) ◽  
pp. G347-G354 ◽  
Author(s):  
P. Pouderoux ◽  
J. A. Logemann ◽  
P. J. Kahrilas
Keyword(s):  
Spatial Distribution ◽  
Infusion Rate ◽  
Volitional Control ◽  
Flow Rates ◽  
Fluid Infusion ◽  
Water Infusion ◽  
Pharyngeal Swallow ◽  
Pharyngeal Swallowing ◽  
Temperature Water

Nonalimentary swallows minimize aspiration by clearing accumulated fluid from the pharynx. This study aimed to define 1) the pharyngeal sensory field to elicit swallowing and 2) the effect of infusion rate, volition, taste, and temperature on pharyngeal swallows. Test solutions were directed into the valleculae at 6.5, 11.5, and 32 ml/min through a catheter in eight healthy volunteers. Deglutition was signaled with electromyography and electroglottography. Spatial distribution of infusate before swallowing was studied using videofluoroscopy coupled with a video timer. Volitional control was assessed with rapid or restrained swallows. Pharyngeal swallow latency decreased as the instillation rate increased, was potently modified with volition, and was unchanged by infusate taste or temperature. Water infusion into the valleculae did not trigger pharyngeal swallowing until liquids overflowed and reached the aryepiglottic folds or pyriform sinuses. The variation in swallow latency among flow rates was mainly due to the duration of liquid containment within the valleculae. This suggests that the valleculae act to contain pharyngeal secretions and residue and prevent aspiration by diverting their contents around the larynx before swallowing.

Severe Burn Injuries Caused by Bioethanol-Design Fireplaces—An Overview on Recreational Fire Threats

2011 ◽  
Vol 32 (2) ◽  
pp. 173-177 ◽  
Author(s):  
Robert Kraemer ◽  
Karsten Knobloch ◽  
Johan Lorenzen ◽  
Karl H. Breuing ◽  
Soeren Koennecker ◽  
...  
Keyword(s):  
Burn Injuries ◽  
Severe Burn ◽  
Severe Burn Injuries
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