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Iwata S, Nishida N, Murakawa S, Hato N. A Case of Thermal Burns of the Larynx in a Toddler. Cureus 2024; 16:e75240. [PMID: 39759694 PMCID: PMC11700680 DOI: 10.7759/cureus.75240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2024] [Indexed: 01/07/2025] Open
Abstract
Thermal burns of the larynx are uncommon but can lead to serious upper airway obstruction due to edema and bleeding, especially in children who may struggle to communicate their symptoms effectively. This report presents the case of a one-year-and-seven-month-old boy who developed stridor and respiratory distress after eating a heated potato, which ultimately required tracheal intubation. The initial evaluation suggested foreign body aspiration; however, laryngoscopy confirmed significant arytenoid swelling and airway narrowing due to thermal burns. Following airway management and intensive care with antibiotics and steroids, the patient was extubated on the third day and discharged without complications on the tenth day. This case highlights the importance of considering thermal burns of the larynx in the differential diagnosis of respiratory symptoms after the ingestion of hot food, particularly in young children. Multidisciplinary collaboration between otolaryngologists, pediatricians, and anesthesiologists is essential for the optimal management of such cases.
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Affiliation(s)
- Shinji Iwata
- Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, JPN
| | - Naoya Nishida
- Otolaryngology, Ehime Prefectural Niihama Hospital, Niihama, JPN
| | - Seitaro Murakawa
- Otolaryngology, Ehime Prefectural Niihama Hospital, Niihama, JPN
| | - Naohito Hato
- Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, JPN
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2
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Dudoignon E, Chevret S, Tsague S, Hamane S, Chaouat M, Plaud B, Vicault E, Mebazaa A, Legrand M, Alanio A, Denis B, Dépret F, Dellière S. Risk Factors and Outcome Associated With Fungal Infections in Patients With Severe Burn Injury: 10-year Retrospective IFI-BURN Study. Clin Infect Dis 2024; 79:682-689. [PMID: 38916974 DOI: 10.1093/cid/ciae337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/08/2024] [Accepted: 06/20/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND In burn patients, skin barrier disruption and immune dysfunctions increase susceptibility to invasive fungal diseases (IFDs) like invasive candidiasis (IC) and invasive mold infections (IMI). We provide an in-depth analysis of IFD-related factors and outcomes in a 10-year cohort of severe burn patients. METHODS This retrospective cohort study includes adult patients admitted to the burn intensive care unit (BICU) between April 2014 and May 2023 with total burn surface area (TBSA) ≥15%. Patients were classified as proven IFD according to EORTC/MSGERC criteria applicable for IC. Putative IMIs were defined with: ≥2 positive cultures from a skin biopsy/bronchoalveolar lavage or ≥2 positive blood specific-quantitative polymerase chain reactions (qPCRs) or a combination of both. RESULTS Among 1381 patients admitted, 276 consecutive patients with TBSA ≥15% were included. Eighty-seven (31.5%; IC n = 30; IMI n = 43; both n = 14) patients fulfilled the criteria for probable/putative IFD. At Day 30 after the burn injury, the estimated cumulative incidence proven/putative (pr/pu) IFD was 26.4% (95% confidence interval [CI], 21.4%-31.8%). Factors independently associated with IFDs were TBSA, severity scores and indoor burn injury (ie, from confined space fire). Overall mortality was 15.3% and 36.8% in the no IFD, pr/pu IFD groups respectively (P < .0001). IFD was independently associated with a risk of death (hazard ratio [HR]: 1.94 for pr/pu IFD; 95% CI, 1.12-3.36; P = .019). CONCLUSIONS This study describes twenty-first-century characteristics of IFDs in severe burn patients confirming known risk factors with thresholds and identifying the indoor injury as an independent factor associated to IFDs. This suggests a link to contamination caused by fire damage, which is highly susceptible to aerosolizing spores.
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Affiliation(s)
- Emmanuel Dudoignon
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital, Université Paris-Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S 942 Mascot, Lariboisière Hospital, Paris, France
- FHU PROMICE, Paris, France
| | - Sylvie Chevret
- Biostatistics Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Cité, Paris, France
| | - Sorel Tsague
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital, Université Paris-Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Samia Hamane
- Parasitology-Mycology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis Paris, France
| | - Marc Chaouat
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital, Université Paris-Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
- Plastic Surgery Department, Saint-Louis Hospital, Assistance Publique- Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Benoit Plaud
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital, Université Paris-Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S 942 Mascot, Lariboisière Hospital, Paris, France
- FHU PROMICE, Paris, France
| | - Eric Vicault
- Biostatistics Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Cité, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital, Université Paris-Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S 942 Mascot, Lariboisière Hospital, Paris, France
- FHU PROMICE, Paris, France
| | - Matthieu Legrand
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, University of California San Francisco, San Francisco, California, USA
- FCRIN-INICRCT, CHU Nancy, France
| | - Alexandre Alanio
- Parasitology-Mycology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis Paris, France
- Translational Mycology Research Group, Mycology Department, Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, F-75015 Paris, France
| | - Blandine Denis
- Infection Disease Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francois Dépret
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis-Lariboisière Hospital, Université Paris-Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S 942 Mascot, Lariboisière Hospital, Paris, France
- FHU PROMICE, Paris, France
| | - Sarah Dellière
- Parasitology-Mycology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis Paris, France
- Institut Pasteur, Université de Paris Cité, Immunobiology d'Aspergillus, Paris, France
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Boccara D, Chaouat M, Serror K, Mimoun M, Vairinho A. Specificities of Management of Perineal Burns. J Burn Care Res 2024; 45:1032-1040. [PMID: 38594952 DOI: 10.1093/jbcr/irae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Indexed: 04/11/2024]
Abstract
There is a paucity of articles addressing the management strategy for perineal burns. Pelvic floor burns present a multitude of problems. These relate to the management of stool, urine, areas of maceration, significant strain, and the risk of infection. The objective of this study was to analyze a consecutive series of perineal burns by studying their characteristics, treatment, and management of urine and feces. This was a retrospective study including 100 patients between January 2018 and December 2022. The patients had all been hospitalized after suffering burns to the perineum. In 28% of the patients, the perineal burn was complicated by infection. In 61% of cases, a cutaneous infection, in 32% of cases, a urinary tract infection, in 25% of cases, a respiratory tract infection, and in 7% of cases, an infection of the digestive tract. Superinfection is associated with an increased risk of poor engraftment. A total of 100% of the patients with poor or average engraftment had an infection in the aftermath of the burn, compared with 20% of the patients with excellent engraftment and 61% of the patients with good engraftment. In our series, the analysis revealed that, in 95% of cases, no specific procedures were implemented for stool management. Perianal involvement was associated with a risk of sub-excellent engraftment. The results were statistically significant, with P = .005 and an OR = 8.72 after multivariate analysis. We favor the least invasive approach to stool management. Indications for a rectal catheter arise in patients with the following characteristics: the patient must be sedated, the burns must be deep and close to the anal opening, and the stools must be watery and abundant. In 95% of cases, we do not install a stool management device. Colostomies should remain exceptional.
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Affiliation(s)
- David Boccara
- Plastic, Reconstructive and Cosmetic and Burn Surgery Unit, Hôpital Saint Louis, Paris, France
| | - Marc Chaouat
- Plastic, Reconstructive and Cosmetic and Burn Surgery Unit, Hôpital Saint Louis, Paris, France
| | - Kevin Serror
- Plastic, Reconstructive and Cosmetic and Burn Surgery Unit, Hôpital Saint Louis, Paris, France
| | - Maurice Mimoun
- Plastic, Reconstructive and Cosmetic and Burn Surgery Unit, Hôpital Saint Louis, Paris, France
| | - Alexandre Vairinho
- Plastic, Reconstructive and Cosmetic and Burn Surgery Unit, Hôpital Saint Louis, Paris, France
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Collier ZJ, Gillenwater J. Fluid Resuscitation and Cardiovascular Support in Acute Burn Care. Clin Plast Surg 2024; 51:205-220. [PMID: 38429044 DOI: 10.1016/j.cps.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Acute burn injury creates a complex and multifactorial local response which may have systemic sequelae such as hypovolemia, hypothermia, cardiovascular collapse, hypercoagulability, and multi-system organ failure. Understanding the underlying pathophysiology of burn shock, the initial burn triage and assessment, calculation of fluid requirements, and the means of tailoring ongoing interventions to optimize resuscitation are critical for overcoming the wide spectrum of derangements which this condition creates. As a result, this article discusses the various key points in order to garner a greater understanding of these nuances and the optimal pathway to take when tackling these challenging issues.
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Affiliation(s)
- Zachary J Collier
- Division of Plastic & Reconstructive Surgery, USC Department of Surgery, University of Chicago, 1510 San Pablo Street, Suite 415, Los Angeles, CA 90033, USA
| | - Justin Gillenwater
- Division of Plastic & Reconstructive Surgery, USC Department of Surgery, University of Chicago, 1510 San Pablo Street, Suite 415, Los Angeles, CA 90033, USA; Plastic and Reconstructive Surgery, University of Southern California.
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García-Ballesteros DI, Rivera-Martínez DDC, García-Pérez MM, Valdés-Flores E, Castro-Govea Y, Chacón-Moreno HJ. Evaluation and Optimization of the Wallace Rule of Nines for the Estimation of Total Body Surface Area in Obese and Nonobese Populations. J Emerg Med 2023; 65:e320-e327. [PMID: 37709577 DOI: 10.1016/j.jemermed.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/10/2023] [Accepted: 05/26/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Currently, the Wallace Rule of Nines is the most widely used method to measure total body surface area (TBSA) in burned patients due to its practicality and speed in its application; however, it often provides inaccurate estimations in obese patients, affecting the fluid resuscitation process. OBJECTIVE In this study, we aimed to modify and optimize the Rule of Nines' values for its application in these patients. METHODS We compared the estimations of the TBSA established by the Wallace Rule of Nines against the measurements of the three-dimensional (3D) software Skanect - Meshmixer 3.5Ⓡ in participants without different obesity grades. Based on our results, we generate an optimized guideline for the evaluation of TBSA in normal body mass index (BMI) and obese patients. RESULTS In our study, 32 participants were recruited with a mean age of 28.5 ± 3.3 years. In the general population, we observed a poor correlation between the Wallace Rule of Nines and the 3D method measures in all body regions (e.g., Anterior Trunk: 18.0 vs. 16.61 ± 2.11, p = 0.0008) except the anterior arm. Interestingly, these differences narrowed in the Trunk and Leg regions as the participants' BMI increased (e.g., Anterior Trunk in Obesity Grade II patients: 18.0 vs. 18.66 ± 1.69, p = 0.3089). CONCLUSIONS We found important differences in TBSA determination using the 3D Skanect-MeshmixerⓇ software compared with the Wallace Rule of Nines. Therefore, we generated a modified and optimized Wallace Rule of Nines estimations based on BMI. Future studies are needed to assess the safety and efficacy of this optimized table.
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Affiliation(s)
- Daniel Iván García-Ballesteros
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Cirugía Plástica, Estética y Reconstructiva, Monterrey, Nuevo León, México
| | - Delia Del Carmen Rivera-Martínez
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Cirugía Plástica, Estética y Reconstructiva, Monterrey, Nuevo León, México
| | - Mauricio Manuel García-Pérez
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Cirugía Plástica, Estética y Reconstructiva, Monterrey, Nuevo León, México
| | - Everardo Valdés-Flores
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Cirugía Plástica, Estética y Reconstructiva, Monterrey, Nuevo León, México
| | - Yanko Castro-Govea
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Cirugía Plástica, Estética y Reconstructiva, Monterrey, Nuevo León, México
| | - Hernán Jesús Chacón-Moreno
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Servicio de Cirugía Plástica, Estética y Reconstructiva, Monterrey, Nuevo León, México
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Ryan CM, Shapiro GD, Rencken CA, Griggs C, Jeng JC, Hickerson WL, Marino M, Goverman J, Kazis LE, Schneider JC, LIBRE Advisory Board. The Impact of Burn Size on Community Participation: A Life Impact Burn Recovery Evaluation (LIBRE) Study. Ann Surg 2022; 276:1056-1062. [PMID: 33351466 PMCID: PMC8265012 DOI: 10.1097/sla.0000000000004703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the association of burn size and community participation as measured by the LIBRE Profile. SUMMARY OF BACKGROUND DATA Burn size is an established clinical predictor of survival after burn injury. It is often a factor in guiding decisions surrounding early medical interventions; however, literature is inconclusive on its relationship to quality of life outcomes. METHODS This is a secondary data analysis of a cross-sectional survey of adult burn survivors. Self-reported data were collected between October 2014 and December 2015 from 601 burn survivors aged ≥18 years with ≥5% total body surface area (TBSA) or burns to critical areas. Sociodemographic characteristics were compared between participants with small burns (≤40% TBSA burned) and large burns (>40% TBSA burned). Ordinary least squares regression models examined associations between burn size and LIBRE Profile scale scores with adjustments for sex, current work status, burns to critical areas, and time since burn injury. RESULTS The analytic sample comprised 562 participants with data available for burn size. 42% of respondents had large burns (>40% TBSA burned) and 58% reported smaller burns (TBSA ≤40%). In adjusted regression models, patients with large burns tended to score lower on the Social Activities and Work & Employment scales ( P < 0.05) and higher on the Family & Friends scale ( P < 0.05). Participants with burns >40% TBSA scored lower for several individual items in the Social Activities scale and one item in the Work & Employment scale ( P < 0.05). CONCLUSIONS Increasing burn size was found to be negatively associated with selected items of Work & Employment and Social Activities, but positively associated with aspects of Family & Friend Relationships. Future longitudinal studies are necessary to assess and understand the long-term social impact of burn injuries on adult populations.
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Affiliation(s)
- Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Shriners Hospitals for Children – Boston, Boston, MA
- Harvard Medical School, Boston, MA
| | - Gabriel D. Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | | | - Cornelia Griggs
- New York Presbyterian/Morgan Stanley Children’s Hospital Department of Pediatric Radiology and Surgery, New York, NY, USA
| | - James C. Jeng
- Nathan Speare Regional Burn Treatment Center, Crozer-Chester Medical Center, Upland, PA
| | | | - Molly Marino
- Quality Measurement and Health Policy Program, RTI International, Waltham, MA
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Lewis E. Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Jeffrey C. Schneider
- Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA
- Spaulding Research Institute, Boston, MA
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Talbert AW, Weber AK, Bitter CC. Odynophagia after celebrating Independence Day. J Am Coll Emerg Physicians Open 2021; 2:e12368. [PMID: 33532758 PMCID: PMC7831615 DOI: 10.1002/emp2.12368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/19/2020] [Accepted: 12/31/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
- Andrew W. Talbert
- Division of Emergency MedicineDepartment of SurgerySaint Louis University School of MedicineSaint LouisMissouriUSA
| | - Alizabeth K. Weber
- Department of Otolaryngology, Head and Neck SurgerySaint Louis University School of MedicineSaint LouisMissouriUSA
| | - Cindy C. Bitter
- Division of Emergency MedicineDepartment of SurgerySaint Louis University School of MedicineSaint LouisMissouriUSA
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Abstract
Management of the pediatric burn patient presents a variety of clinical challenges for the pediatric anesthesiologist. Despite the high incidence of burn injuries, standard management strategies are far from universal. The complex physiologic changes presented by burn injuries present airway management and resuscitation challenges and mandate careful consideration of adequate nutritional support. Long hospital stays with frequent operations and dressing changes necessitate creative approaches to anxiolysis and pain control. Underutilized modalities warranting further research include regional anesthesia and nonpharmacologic approaches, such as virtual reality. Further research and collaboration between burn centers are needed to standardize care for this population.
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Chu MMH, Tse A, Anderco I, Cardozo A. Fatal laryngeal burn from ingestion of a hot fish cake: Case report and literature review. Int J Surg Case Rep 2020; 72:639-642. [PMID: 32527705 PMCID: PMC7365770 DOI: 10.1016/j.ijscr.2020.04.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Laryngeal burn from hot food ingestion is a rare but potentially life-threatening presentation. It is essential that clinicians have a high index of suspicion of potential airway obstruction in such cases. To our knowledge, this is the only case of fatal laryngeal oedema caused by hot solid food ingestion reported in the literature. PRESENTATION OF CASE A 51 year old male presented to the Emergency Department complaining of a burn to the throat following ingestion of a piping hot fish cake. On initial assessment he reported only mild pain and increased saliva production. There was no evidence of stridor, dysphagia, dyspnoea or aspiration and hence the patient was discharged and advised to return if he experienced any worsening of his symptoms. 2 h later the patient collapsed at home and died due to airway obstruction from delayed laryngeal oedema. DISCUSSION 27 cases of laryngeal burn from ingestion of hot food or liquid were identified in the literature. Only one fatality following ingestion of hot liquid has been reported. This is the first documented fatal laryngeal burn due to ingestion of hot solid food. At present, there are no guidelines for the assessment and management of laryngeal contact burns. CONCLUSION Patients may be relatively asymptomatic immediately after thermal injury to the larynx. Endoscopic examination of the larynx is required to identify laryngeal oedema. Any sign of thermal injury to the laryngeal mucosa warrants admission for observation and definitive management of the airway should be considered.
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Affiliation(s)
- Michael M H Chu
- Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Fulwood, Preston PR2 9HT, United Kingdom.
| | - Antonia Tse
- Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Fulwood, Preston PR2 9HT, United Kingdom
| | - Ileana Anderco
- Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Fulwood, Preston PR2 9HT, United Kingdom
| | - Arun Cardozo
- Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Fulwood, Preston PR2 9HT, United Kingdom
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Yoshino Y, Hashimoto A, Ikegami R, Irisawa R, Kanoh H, Sakurai E, Nakanishi T, Maekawa T, Tachibana T, Amano M, Hayashi M, Ishii T, Iwata Y, Kawakami T, Sarayama Y, Hasegawa M, Matsuo K, Ihn H, Omoto Y, Madokoro N, Isei T, Otsuka M, Kukino R, Shintani Y, Hirosaki K, Motegi S, Kawaguchi M, Asai J, Isogai Z, Kato H, Kono T, Tanioka M, Fujita H, Yatsushiro H, Sakai K, Asano Y, Ito T, Kadono T, Koga M, Tanizaki H, Fujimoto M, Yamasaki O, Doi N, Abe M, Inoue Y, Kaneko S, Kodera M, Tsujita J, Fujiwara H, Le Pavoux A. Wound, pressure ulcer and burn guidelines – 6: Guidelines for the management of burns, second edition. J Dermatol 2020; 47:1207-1235. [DOI: 10.1111/1346-8138.15335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 01/28/2023]
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Prevalence and prognostic impact of inhalation injury among burn patients: A systematic review and meta-analysis. J Trauma Acute Care Surg 2020; 88:330-344. [PMID: 31688831 DOI: 10.1097/ta.0000000000002523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of our study was to perform a systematic review and meta-analysis aimed at assessing the prevalence of inhalation injury in burn patients and its prognostic value in relation to in-hospital mortality. METHODS We searched the PubMed and EMBASE databases for noninterventional studies published between 1990 and 2018 investigating in-hospital mortality predictors among burn patients.The primary meta-analysis evaluated the association between inhalation injury and mortality. A secondary meta-analysis determined the global estimate of the prevalence of inhalation injury and the rate of mortality. Random effects models were used, and univariate meta-regressions were used to assess sources of heterogeneity. This study is registered in the PROSPERO database with code CRD42019127356. FINDINGS Fifty-four studies including a total of 408,157 patients were selected for the analysis. A pooled inhalation prevalence of 15.7% (95% confidence interval, 13.4%-18.3%) was calculated.The summarized odds ratio of in-hospital mortality secondary to an inhalation injury was 3.2 (95% confidence interval, 2.5-4.3). A significantly higher odd of mortality was found among the studies that included all hospitalized burn patients, those that included a lower proportion of male patients, those with a lower mean total body surface area, and those with a lower prevalence of inhalation injury. CONCLUSION Despite our study's limitations due to the high risk of bias and the interstudy heterogeneity of some of our analyses, our results revealed a wide range of prevalence rates of inhalation injury and a significant association between this entity and in-hospital mortality in burn patients. However, this association is not significant if adjusted for disease severity. LEVEL OF EVIDENCE Systematic review/meta-analysis, level III.
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12
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Matsumura K, Yamamoto R, Kamagata T, Kurihara T, Sekine K, Takuma K, Kase K, Sasaki J. A novel scale for predicting delayed intubation in patients with inhalation injury. Burns 2020; 46:1201-1207. [PMID: 31982185 DOI: 10.1016/j.burns.2019.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/17/2019] [Accepted: 12/31/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Strategies to predict delayed airway obstruction in patients with inhalation injury have not been extensively studied. This study aimed to develop a novel scale, predicting the need for Delayed Intubation after inhalation injury (PDI) score. METHODS We retrospectively identified patients with inhalation injury at four tertiary care centers in Japan between 2012 and 2018. We included patients aged 15 or older and excluded those intubated within 30 min after hospital arrival. Predictors for delayed intubation were identified with univariate analyses and scored on the basis of odds ratios. The PDI score was evaluated with the area under the receiver operating characteristic (AUROC) curve and compared with other scaling systems for burn injuries. RESULTS Data from 158 patients were analyzed; of these patients, 18 (11.4%) were intubated during the delayed phase. Signs of respiratory distress, facial burn, and pharyngolaryngeal swelling observed on laryngoscopy, were identified as predictors for delayed intubation. The discriminatory power of the PDI (AUROC curve = 0.90; 95% confidence interval, 0.83 to 0.97; p < 0.01) was higher than that of the other scaling systems. CONCLUSIONS We developed a novel scale for predicting delayed intubation in inhalation injury. The score should be further validated with other population.
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Affiliation(s)
- Kazuki Matsumura
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Tomohiro Kamagata
- Department of Emergency and Critical Care Medicine, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minatoku, Tokyo, 108-0073, Japan
| | - Tomohiro Kurihara
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Kazuhiko Sekine
- Department of Emergency and Critical Care Medicine, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minatoku, Tokyo, 108-0073, Japan
| | - Kiyotsugu Takuma
- Department of Emergency Medicine, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawadori, Kawasakiku, Kanagawa, 210-0013, Japan
| | - Kenichi Kase
- Department of Emergency Medicine, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, 321-9574, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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Dépret F, Hoffmann C, Daoud L, Thieffry C, Monplaisir L, Creveaux J, Annane D, Parmentier E, Mathieu D, Wiramus S, Demeure DIt Latte D, Kpodji A, Textoris J, Robin F, Klouche K, Pontis E, Schnell G, Barbier F, Constantin JM, Clavier T, du Cheyron D, Terzi N, Sauneuf B, Guerot E, Lafon T, Herbland A, Megarbane B, Leclerc T, Mallet V, Pirracchio R, Legrand M. Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:421. [PMID: 31870461 PMCID: PMC6929494 DOI: 10.1186/s13054-019-2706-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/16/2019] [Indexed: 11/10/2022]
Abstract
Background The use of hydroxocobalamin has long been advocated for treating suspected cyanide poisoning after smoke inhalation. Intravenous hydroxocobalamin has however been shown to cause oxalate nephropathy in a single-center study. The impact of hydroxocobalamin on the risk of acute kidney injury (AKI) and survival after smoke inhalation in a multicenter setting remains unexplored. Methods We conducted a multicenter retrospective study in 21 intensive care units (ICUs) in France. We included patients admitted to an ICU for smoke inhalation between January 2011 and December 2017. We excluded patients discharged at home alive within 24 h of admission. We assessed the risk of AKI (primary endpoint), severe AKI, major adverse kidney (MAKE) events, and survival (secondary endpoints) after administration of hydroxocobalamin using logistic regression models. Results Among 854 patients screened, 739 patients were included. Three hundred six and 386 (55.2%) patients received hydroxocobalamin. Mortality in ICU was 32.9% (n = 243). Two hundred eighty-eight (39%) patients developed AKI, including 186 (25.2%) who developed severe AKI during the first week. Patients who received hydroxocobalamin were more severe and had higher mortality (38.1% vs 27.2%, p = 0.0022). The adjusted odds ratio (95% confidence interval) of AKI after intravenous hydroxocobalamin was 1.597 (1.055, 2.419) and 1.772 (1.137, 2.762) for severe AKI; intravenous hydroxocobalamin was not associated with survival or MAKE with an adjusted odds ratio (95% confidence interval) of 1.114 (0.691, 1.797) and 0.784 (0.456, 1.349) respectively. Conclusion Hydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation. Trial registration ClinicalTrials.gov, NCT03558646
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Affiliation(s)
- François Dépret
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, GH Saint Louis-Lariboisière, Paris, France.,UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.,F-CRIN, INICRCT network, Paris, France.,Paris Diderot University, F-75475, Paris, France
| | - Clément Hoffmann
- Burn Center, Percy Military Teaching Hospital, BP 406, 101, avenue Henri-Barbusse, 92141, Clamart CEDEX, France
| | - Laura Daoud
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, GH Saint Louis-Lariboisière, Paris, France
| | - Camille Thieffry
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital, F-59037, Lille CEDEX, France
| | - Laure Monplaisir
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, GH Saint Louis-Lariboisière, Paris, France
| | - Jules Creveaux
- Burn Center, Percy Military Teaching Hospital, BP 406, 101, avenue Henri-Barbusse, 92141, Clamart CEDEX, France
| | - Djillali Annane
- General ICU, Service de Réanimation, Hôpital Raymond Poincaré, Laboratory of Infection and Inflammation, U1173, AP-HP, University of Versailles SQY and INSERM, 104 Boulevard Raymond Poincaré, 92380, Garches, France
| | - Erika Parmentier
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital, F-59037, Lille CEDEX, France
| | - Daniel Mathieu
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital, F-59037, Lille CEDEX, France
| | - Sandrine Wiramus
- Centre de traitement des grands brûlés Hopital de la Conception APHM, 147 boulevard Baille, 13005, Marseille, France
| | | | - Aubin Kpodji
- Centre de traitement des grands brûlés Hopital de Mercy,1 Allée du Château, 57245 Ars-Laquenexy-C.H.R Metz-, Thionville, France
| | - Julien Textoris
- Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon-Université Claude Bernard Lyon 1, Lyon, France
| | - Florian Robin
- Anesthesiology and Critical Care Medicine, CHU Bordeaux, Place Amélie Raba Léon, 33000, Bordeaux, France
| | - Kada Klouche
- Intensive Care Medicine Department, University of Montpellier Lapeyronie Hospital, 371, Av Doyen Gaston Giraud, 34295, Montpellier, France
| | - Emmanuel Pontis
- Intensive Care Medicine Department, CHU de Rennes, 2 rue Henri Le Guilloux, 35033, Rennes CEDEX 9, France
| | - Guillaume Schnell
- Service de réanimation médico-chirurgicale, Groupe Hospitalier du Havre-Hôpital Jacques Monod, Montivilliers, France
| | - François Barbier
- Medical Intensive Care Unit, La Source Hospital, CHR Orléans, Orléans, France
| | - Jean-Michel Constantin
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Thomas Clavier
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France.,Normandie Univ, UNIROUEN, INSERM U1096, Rouen, France
| | - Damien du Cheyron
- Medical Intensive Care Unit, Caen University Hospital, Avenue côte de Nacre, 14033, Caen CEDEX, France
| | - Nicolas Terzi
- Service de Réanimation Médicale, Centres Hospitaliers Universitaires Grenoble Alpes, Grenoble, France
| | - Bertrand Sauneuf
- Service de Réanimation Médicale Polyvalente, Centre Hospitalier Public du Cotentin, BP 208, 50102, Cherbourg-Octeville, France
| | - Emmanuel Guerot
- Service de Réanimation Médicale, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Thomas Lafon
- Département des urgences, service des urgences, SAMU, CHU de Limoges, 87042, Limoges CEDEX, France.,Inserm CIC 1435, 87042, Limoges, France
| | | | - Bruno Megarbane
- Service de réanimation médicale et toxicologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Vincent Mallet
- Service d'hépato gastro entérologie Hôpital Cochin, hépato Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Pirracchio
- Department of Anesthesia and perioperative care, University of California San Francisco, San Francisco, USA
| | - Matthieu Legrand
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, GH Saint Louis-Lariboisière, Paris, France. .,UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France. .,F-CRIN, INICRCT network, Paris, France. .,Burn Center, Percy Military Teaching Hospital, BP 406, 101, avenue Henri-Barbusse, 92141, Clamart CEDEX, France. .,Department of Anesthesiology and Perioperative care Parnassus hospital, UCSF, San Francisco, USA.
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Uppuluri VNVA, Shanmugarajan TS. Icariin-Loaded Polyvinyl Alcohol/Agar Hydrogel: Development, Characterization, and In Vivo Evaluation in a Full-Thickness Burn Model. INT J LOW EXTR WOUND 2019; 18:323-335. [PMID: 31140339 DOI: 10.1177/1534734619849982] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tissue regeneration has become a promising strategy for repairing damaged skin tissues. Among the hydrogels for tissue regeneration applications, topical hydrogels have demonstrated great potential for use as 3D-scaffolds in the burn wound healing process. Currently, no report has been published specifically on icariin-loaded polyvinyl alcohol (PVA)/agar hydrogel on full-thickness burn wounds. In the present study, burn tissue regeneration based on biomimetic hydrogel scaffolds was used for repairing damaged extracellular matrix. Furthermore, a skin burn model was developed in rats, and the icariin-loaded PVA/agar hydrogels were implanted into the damaged portions. The regeneration of the damaged tissues with the help of the icariin-loaded hydrogel group exhibited new translucent skin tissues and repaired extracellular matrix, indicating that the hydrogel can enhance the wound healing process. Moreover, characterization studies such as X-ray diffraction, Fourier-transformed infrared spectroscopy, and differential scanning calorimetry reported the extent of compatibility between icariin and its polymers. Results of the field emission scanning electron microscopy images revealed the extent of the spread of icariin within the polymer-based hydrogel. Furthermore, the wound healing potential, confirmed by histopathological and histochemical findings at the end of 21 days, revealed the visual evidence for the biomimetic property of icariin-loaded PVA/agar hydrogel scaffolds with the extracellular matrix for tissue regeneration.
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Affiliation(s)
| | - T S Shanmugarajan
- Vels Institute of Science, Technology & Advanced Studies (VISTAS), Chennai, India
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15
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Moshrefi S, Sheckter CC, Shepard K, Pereira C, Davis DJ, Karanas Y, Rochlin DH. Preventing Unnecessary Intubations: A 5-Year Regional Burn Center Experience Using Flexible Fiberoptic Laryngoscopy for Airway Evaluation in Patients With Suspected Inhalation or Airway Injury. J Burn Care Res 2019; 40:341-346. [DOI: 10.1093/jbcr/irz016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shawn Moshrefi
- Regional Burn Center, Santa Clara Valley Medical Center, San Jose, California
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California
| | - Clifford C Sheckter
- Regional Burn Center, Santa Clara Valley Medical Center, San Jose, California
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California
| | - Kimberly Shepard
- Division of Otolaryngology, Santa Clara Valley Medical Center, San Jose, California
| | - Clifford Pereira
- Regional Burn Center, Santa Clara Valley Medical Center, San Jose, California
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California
| | - Drew J Davis
- Regional Burn Center, Santa Clara Valley Medical Center, San Jose, California
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California
| | - Yvonne Karanas
- Regional Burn Center, Santa Clara Valley Medical Center, San Jose, California
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California
| | - Danielle H Rochlin
- Regional Burn Center, Santa Clara Valley Medical Center, San Jose, California
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California
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16
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Maiden MJ, Finnis ME, Peake S, McRae S, Delaney A, Bailey M, Bellomo R. Haemoglobin concentration and volume of intravenous fluids in septic shock in the ARISE trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:118. [PMID: 29724246 PMCID: PMC5934793 DOI: 10.1186/s13054-018-2029-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/06/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Intravenous fluids may contribute to lower haemoglobin levels in patients with septic shock. We sought to determine the relationship between the changes in haemoglobin concentration and the volume of intravenous fluids administered during resuscitation from septic shock. METHODS We performed a retrospective cohort study of patients enrolled in the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial who were not transfused red blood cells (N = 1275). We determined the relationship between haemoglobin concentration, its change over time and volume of intravenous fluids administered over 6, 24 and 72 h using univariate and multivariate analysis. RESULTS Median (IQR) haemoglobin concentration at baseline was 133 (118-146) g/L and decreased to 115 (102-127) g/L within the first 6 h of resuscitation (P < 0.001), 110 (99-122) g/L after 24 h, and 109 (97-121) g/L after 72 h. At the corresponding time points, the cumulative volume of intravenous fluid administered was 1.3 (0.7-2.2) L, 2.9 (1.8-4.3) L and 4.6 (2.7-7.1) L. Haemoglobin concentration and its change from baseline had an independent but weak association with intravenous fluid volume at each time point (R2 < 20%, P < 0.001). After adjusting for covariates, each litre of intravenous fluid administered was associated with a change in haemoglobin concentration of - 1.0 g/L (95% CI -1.5 to -0.6, P < 0.001) at 24 h and - 1.3 g/L (- 1.6 to - 0.9, P < 0.001) at 72 h. CONCLUSIONS Haemoglobin concentration decreases during resuscitation from septic shock, and has a significant but weak association with the volume of intravenous fluids administered.
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Affiliation(s)
- Matthew J Maiden
- Intensive Care Unit, University Hospital Geelong, Barwon Health, PO Pox 281, Geelong, Victoria, Australia. .,Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia. .,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia.
| | - Mark E Finnis
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Sandra Peake
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia.,Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Clayton, Victoria, Australia
| | - Simon McRae
- Department of Haematology, SA Pathology, Adelaide, South Australia, Australia
| | - Anthony Delaney
- Intensive Care Unit, Royal North Shore Hospital, St Leonard's, New South Wales, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Clayton, Victoria, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Clayton, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Monash University, Clayton, Victoria, Australia.,Critical Care Services, Monash Health, Clayton, Victoria, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, Monash University, Clayton, Victoria, Australia.,School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Intensive Care, Austin Hospital, Melbourne, Australia.,Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
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17
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Zissman S, Orgil M, Ben-Amotz O, Gur E, Arad E, Leshem D. Pediatric burns in Israeli natives versus asylum seekers living in Israel: Lessons learned. Burns 2018; 44:1322-1329. [PMID: 29605224 DOI: 10.1016/j.burns.2018.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Burn injuries are one of the leading causes of morbidity and mortality in the pediatric population. In early childhood, burns have a wide range of adverse long-term consequences ranging from functional impairment to psychological implications. Children from low-income and middle-income countries are at a higher risk of suffering from burn injuries. In the last 10 years the population of asylum seekers from low-income countries in Israel has increased dramatically. About 25,000 or 60% of asylum seekers are living in the Tel Aviv area, making up roughly 6% of the city's total population (about 405,000). AIM A retrospective study aimed to profile the pediatric burn injuries treated at the Tel Aviv Sourasky Medical Center over the last 9 years in an effort to examine the distinct characteristics of African asylum seekers who suffer burn injuries in comparison with Israeli nationals. PATIENTS & METHODS Medical records of 876 patients under the age of 18 years presenting between 2007-2015 were retrospectively reviewed. The parameters collected included gender, causality, total body surface area (TBSA), burn depth and patient outcome. CONCLUSIONS There was no significant difference regarding: age; male-female ratio; scald-types burns; limb involvement. However, hospitalization and length of hospital stay were significantly higher among asylum seekers, as was family burden. Questions may be raised regarding prevention, education & social support. Our research provides a small glimpse into the world of asylum seekers in Israel. We hope it will serve as a window into the much grander problems that this population faces on a daily basis.
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Affiliation(s)
- Sivan Zissman
- Pediatric & Craniofacial Plastic Surgery Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Matan Orgil
- Pediatric & Craniofacial Plastic Surgery Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oded Ben-Amotz
- Pediatric & Craniofacial Plastic Surgery Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Gur
- Pediatric & Craniofacial Plastic Surgery Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ehud Arad
- Pediatric & Craniofacial Plastic Surgery Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Leshem
- Pediatric & Craniofacial Plastic Surgery Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Badulak JH, Schurr M, Sauaia A, Ivashchenko A, Peltz E. Defining the criteria for intubation of the patient with thermal burns. Burns 2018; 44:531-538. [PMID: 29548862 DOI: 10.1016/j.burns.2018.02.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Recent studies demonstrate that burn patients are undergoing unnecessary intubations. We sought to determine the clinical criteria that predict intubations with benefit. METHODS This was a retrospective review of intubated adults admitted to our center with thermal burns 2008-2013. Criteria for intubation were defined as traditional criteria (suspected smoke inhalation, oropharynx soot, hoarseness, dysphagia, singed facial hair, oral edema, oral burn, non-full thickness facial burns), or ABA criteria as defined by the 2011 ABA guidelines (full thickness facial burns, stridor, respiratory distress, swelling on laryngoscopy, upper airway trauma, altered mentation, hypoxia/hypercarbia, hemodynamic instability). Patients with <26days free from mechanical ventilation (ventilator-free days (VFD)) out of 28, were deemed indicated long-term intubations. Those with ≥26 VFD were deemed unnecessary short-term intubations. RESULTS Of 218 patients, 151 had long-term and 67 had short-term intubations. Long-term intubation was strongly associated with ABA criteria (77.5%) compared to traditional criteria (22.5%) (p<0.001). Sensitivity of ABA criteria for long-term intubation was 77% and specificity 46%. Traditional criteria associated with long-term intubation included suspected smoke inhalation (OR 2.45 [95% CI, 1.18-5.11]), and singed facial hair (OR 2.53 [95% CI, 1.25-5.09]). The addition of these to ABA criteria created the Denver criteria, which exhibited an increased sensitivity for long-term intubations (95%), but decreased specificity (24%). CONCLUSIONS Intubation should be considered for patients displaying the Denver criteria, which includes full thickness facial burns, stridor, respiratory distress, swelling on laryngoscopy, upper airway trauma, altered mentation, hypoxia/hypercarbia, hemodynamic instability, suspected smoke inhalation, and singed facial hair. Patients lacking these criteria should not be intubated.
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Affiliation(s)
- Jenelle H Badulak
- University of Washington, Division of Pulmonary, Critical Care and Sleep Medicine, 1959 NE Pacific Street, Seattle, WA 98195, United States.
| | - Michael Schurr
- Mountain Area Health Education Center, Division of General Surgery, 121 Hendersonville Road, Asheville, NC 28803, United States.
| | - Angela Sauaia
- University of Colorado, Department of Surgery, 12631 E. 17th Avenue, C-305, Aurora, CO 80045, United States.
| | - Anna Ivashchenko
- University of Colorado, Department of Surgery, 12631 E. 17th Avenue, C-305, Aurora, CO 80045, United States.
| | - Erik Peltz
- University of Colorado, Department of Surgery, 12631 E. 17th Avenue, C-305, Aurora, CO 80045, United States.
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Garcia-Espinoza JA, Aguilar-Aragón VB, García-Méndez S. Use of the CONUT Index as a Predictor of Integration Of Cutaneous Grafts in Burn Patients. J Cutan Aesthet Surg 2018; 10:172-176. [PMID: 29403192 PMCID: PMC5782445 DOI: 10.4103/jcas.jcas_83_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To present the initial experience of 12 patients with burns treated with cutaneous grafts and to analyse the variables that influence their integration. Materials and Methods: We analysed data from 12 patients seen in a year in the regional hospital of high speciality of Oaxaca. Quantified variables: Age, sex, burned body surface, depth of burn, airway injury, nutritional status by CONUT index, type of graft, development of local infection and days of hospital stay. Results: We included 10 men (83%) and 2 women (17%) with median age of 28 years, median burned body surface area of 19%, depth: 75% were mixed burns and 25% were third degree; with median time between injury and application of grafts of 13 days, 1 patient presented airway injury and 50% concomitant trauma. Regarding Nutritional Status: Fifty percent had severe malnutrition, 33% moderate and 16% mild. About 67% of the grafts were meshed and 33% intact, the mean integration percentage was 80%, 25% developed local infection and the average length of hospital stay was 21 days. Conclusions: Cutaneous grafts are the definitive treatment of burns, in their integration process influence different factors, including nutritional status. The CONUT index seems to be a useful, safe and widely available tooling in the nutritional assessment of the burned patient and can be related to the percentage of integration of the grafts and the days of hospital stay.
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20
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Aissa I, Meziane M, El Koundi A, Bensghir M, Siah S, Alaoui SJ. Refractory collapse and severe burn: Think about acute adrenal insufficiency. Am J Emerg Med 2018; 36:733.e1-733.e2. [PMID: 29306651 DOI: 10.1016/j.ajem.2017.12.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/28/2017] [Accepted: 12/28/2017] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Adrenal insufficiency (AI) is a rare endocrine disorder, which can in its acute form be life-threatening in case of late diagnosis or treatment. The stress during a thermal burn can easily decompensate the AI. We report the case of an acute adrenal insufficiency (AAI) discovered following a refractory collapse occurred after a severe thermal burn. CASE PRESENTATION A 60-year-old woman was accidentally burned to the lower limbs by hot water. Total burn surface area was 36 %. The patient had local care and dressings, vascular filling, and analgesics. Four hours later, she became dyspneic, and presented tachycardia associated with collapse at 60/40mmHg. Suspecting a hypovolemic origin, we performed a solid fluid replacement with colloids. However, hemodynamic stability was not achieved and motivated a continuous injection of norepinephrine. Despite high doses, immediate evolution was marked by a persistent precarious hemodynamic state. AAI was suspected, and a substitutive hormonotherapy was started. The clinical condition progressively improved and catecholamines were quickly stopped. CONCLUSION AAI is a vital emergency. The large burn is a possible cause of the AI decompensation. This diagnosis must be kept in mind when the hemodynamic status remains unstable despite an adequate vascular treatment.
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Affiliation(s)
- Ismail Aissa
- Department of Anesthesiology and Intensive Care, Military Hospital Med V, Faculty of Medicine and Pharmacy of Rabat, University Souissi-Med V, Rabat, Morocco.
| | - Mohammed Meziane
- Department of Anesthesiology and Intensive Care, Military Hospital Med V, Faculty of Medicine and Pharmacy of Rabat, University Souissi-Med V, Rabat, Morocco
| | - Abdelghafour El Koundi
- Department of Anesthesiology and Intensive Care, Military Hospital Med V, Faculty of Medicine and Pharmacy of Rabat, University Souissi-Med V, Rabat, Morocco
| | - Mustapha Bensghir
- Department of Anesthesiology and Intensive Care, Military Hospital Med V, Faculty of Medicine and Pharmacy of Rabat, University Souissi-Med V, Rabat, Morocco
| | - Samir Siah
- Department of Anesthesiology and Intensive Care, Military Hospital Med V, Faculty of Medicine and Pharmacy of Rabat, University Souissi-Med V, Rabat, Morocco
| | - Salim Jaafar Alaoui
- Department of Anesthesiology and Intensive Care, Military Hospital Med V, Faculty of Medicine and Pharmacy of Rabat, University Souissi-Med V, Rabat, Morocco
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Acute Kidney Injury in Burn Patients: Clinically Significant Over the Initial Hospitalization and 1 Year After Injury: An Original Retrospective Cohort Study. Ann Surg 2017; 266:376-382. [PMID: 27611620 DOI: 10.1097/sla.0000000000001979] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To examine the development of acute kidney injury (AKI) after burn injury as an independent risk factor for increased morbidity and mortality over initial hospitalization and 1-year follow-up. BACKGROUND Variability in fluid resuscitation and difficulty recognizing early sepsis are major barriers to preventing AKI after burn injury. Expanding our understanding of the burden AKI has on the clinical course of burn patients would highlight the need for standardized protocols. METHODS We queried the Healthcare Cost and Utilization Project State Inpatient Databases in the states of Florida and New York during the years 2009 to 2013 for patients over age 18 hospitalized with a primary diagnosis of burn injury using ICD-9 codes. We identified and grouped 18,155 patients, including 1476 with burns >20% total body surface area, by presence of AKI. Outcomes were compared in these cohorts via univariate analysis and multivariate logistic regression models. RESULTS During initial hospitalization, AKI was associated with increased pulmonary failure, mechanical ventilation, pneumonia, myocardial infarction, length of stay, cost, and mortality, and also a lower likelihood of being discharged home. One year after injury, AKI was associated with development of chronic kidney disease, conversion to chronic dialysis, hospital readmission, and long-term mortality. CONCLUSIONS AKI is associated with a profound and severe increase in morbidity and mortality in burn patients during initial hospitalization and up to 1 year after injury. Consensus protocols for initial burn resuscitation and early sepsis recognition and treatment are crucial to avoid the consequences of AKI after burn injury.
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Abstract
Management of severe burn injury (SBI) requires prompt, complex, and aggressive care. Despite major advances in the management of SBI-including patient-targeted resuscitation, management of inhalation injuries, specific nutritional support, enhanced wound therapy, and infection control-the consequences of SBI often result in complex, multiorgan metabolic changes. Consensus guidelines and clinical evidence regarding specific management of small animal burn patients are lacking. This article aims to review updated therapeutic consideration for the systemic and local management of SBI that are proven effective to optimize outcomes in human burn patients and may translate to small animal patients.
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23
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Bourdon RT, Nelson-Cheeseman BB, Abraham JP. Review of the initial treatment and avoidance of scald injuries. World J Dermatol 2017; 6:17-26. [DOI: 10.5314/wjd.v6.i2.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/13/2017] [Indexed: 02/06/2023] Open
Abstract
Scald injuries, which describe burns to living tissue from hot liquids, are a very common injury that occur across geographical, social, economic, and national boundaries. Despite their ubiquitous nature, a complete understanding of the conditions which are required to cause scald burns is not yet available. In addition, clear guidance to medical practitioners is available through various guidelines however in actual situations, the extent of the burn is not fully known and this lack of knowledge complicates care. Here, a comprehensive review is made of the available knowledge of temperatures and scald durations which lead to skin-burn injuries. The range of volumes and liquid temperatures are typical of those found in heated consumer beverages. This review can help medical practitioners design initial treatment protocols and can be used by manufacturers of hot-liquid products to avoid the most severe burns. Next, within the context of this ability to quantify burn depths, a review of current burn treatment guidelines is given. Included in this review is a visual recognition of the extent of burns into the dermal layer as well as decision guidelines for selection of patients which would benefit from referral to a dedicated burn center. It is hoped that by bringing together both the quantified burn-depth information and current treatment guidelines, this review can be used as a resource for persons in the medical, manufacturing, beverage service, and other industries to reduce the human impact of scald injuries.
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Pensalfini M, Ehret AE, Stüdeli S, Marino D, Kaech A, Reichmann E, Mazza E. Factors affecting the mechanical behavior of collagen hydrogels for skin tissue engineering. J Mech Behav Biomed Mater 2017; 69:85-97. [DOI: 10.1016/j.jmbbm.2016.12.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 12/13/2022]
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Abstract
This article reviews the pathophysiology of large burn injury and the extreme fluid shifts that occur in the hours and days after this event. The authors focus on acute fluid management, monitoring of hemodynamic status, and end points of resuscitation. Understanding the need and causes for fluid resuscitation after burn injury helps the clinician develop an effective plan to balance the competing goals of normalized tissue perfusion and limited tissue edema. Thoughtful, individualized treatment is the best answer and the most effective compromise.
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Xuebijing injection treatment inhibits vasopermeability and reduces fluid requirements in a canine burn model. Eur J Trauma Emerg Surg 2017; 43:875-882. [PMID: 28070608 DOI: 10.1007/s00068-016-0748-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE High vasopermeability and excessive inflammation following severe burns may result in tissue edema, organ dysfunction and the loss of circulatory plasma volume, which can influence the doctor to do the prognosis to the patients. The study aims to examine whether Xuebijing injection (XBJ), an extracts of a traditional Chinese medicine used to treat sepsis in clinic, can reduces fluid requirements by inhibiting vasopermeability and tissue edema in a canine model after burn injury. METHODS Twenty-four beagle dogs were subjected to 50% TBSA burns, and then were randomly allocated to the following three groups: lactated Ringer's resuscitation (LR) group (n = 8), immediate LR containing Xuebijing injection (LR/XBJ) group (n = 8), and operation control group (n = 8). Hemodynamic variables and net fluid accumulation were measured. Blood samples were collected for measurement of hematocrit and circulatory plasma volume (PV). At 24 h after burn injury, heart, lung, small intestine and kidney were harvested for evaluation of the activities of myeloperoxidase (MPO) and neutrophil elastase (NE), vasopermeability, tissue water content and the amount of neutrophil infiltration. RESULTS XBJ treatment significantly reduced net fluid accumulation, and pulmonary vascular permeability index (PVPI), extravascular lung water index (ELWI), and water content of heart, small intestine, kidney and lung compared with LR group. Furthermore, XBJ infusion significantly reduced tissue activities of MPO and NE compared with LR group. The amount of neutrophil infiltration in LR/XBJ group was lower than that in LR group. CONCLUSIONS These results indicate that XBJ injection can reduce fluid requirements by inhibition of neutrophil protease-induced high vasopermeability and tissue edema.
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Incidence and patterns of injury-related mortality: a register-based follow-up study in Alexandria, Egypt (2000-2010). J Egypt Public Health Assoc 2016; 87:8-15. [PMID: 22415330 DOI: 10.1097/01.epx.0000411445.41001.da] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Injuries, with their grave social and economic consequences, although preventable, are an important cause of death in individuals in their most productive earning years, especially in developing countries. This study aimed to determine the incidence and describe the patterns of injury-related mortality in Alexandria, Egypt, through 2000-2010, and to identify their association with some demographic characteristics. MATERIALS AND METHODS Data were collected from the information and decision support center in Alexandria, as case records, for the period 2000-2010. STATA 11 software was used. Time-series analyses (trends and seasonality) were performed for all injuries combined and separately. The association between demographic characteristics and injury-related mortalities was determined using zero-inflated Poisson regression. RESULTS Injury-related mortalities comprised a total of 19 731 deaths between 2000 and 2010 (the incidence ranged between 38.3/100 000 and 51.1/100,000). Road traffic accident was the first leading cause. Almost 70% of injury-related deaths occurred in the age group 15 to <60 years. Men were more at risk than women for all types of injuries, except burns. Higher rates were calculated for poor and remote districts. Summer months showed the highest seasonal index for each type and all combined. CONCLUSION AND RECOMMENDATION Policy makers need to recognize injuries as a public health crisis, especially road traffic accidents, and need to design and implement urgent interventions for safety applicable to the Egyptian demography and distribution.
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Yoshino Y, Ohtsuka M, Kawaguchi M, Sakai K, Hashimoto A, Hayashi M, Madokoro N, Asano Y, Abe M, Ishii T, Isei T, Ito T, Inoue Y, Imafuku S, Irisawa R, Ohtsuka M, Ogawa F, Kadono T, Kawakami T, Kukino R, Kono T, Kodera M, Takahara M, Tanioka M, Nakanishi T, Nakamura Y, Hasegawa M, Fujimoto M, Fujiwara H, Maekawa T, Matsuo K, Yamasaki O, Le Pavoux A, Tachibana T, Ihn H. The wound/burn guidelines - 6: Guidelines for the management of burns. J Dermatol 2016; 43:989-1010. [PMID: 26971391 DOI: 10.1111/1346-8138.13288] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 12/16/2022]
Abstract
Burns are a common type of skin injury encountered at all levels of medical facilities from private clinics to core hospitals. Minor burns heal by topical treatment alone, but moderate to severe burns require systemic management, and skin grafting is often necessary also for topical treatment. Inappropriate initial treatment or delay of initial treatment may exert adverse effects on the subsequent treatment and course. Therefore, accurate evaluation of the severity and initiation of appropriate treatment are necessary. The Guidelines for the Management of Burn Injuries were issued in March 2009 from the Japanese Society for Burn Injuries as guidelines concerning burns, but they were focused on the treatment for extensive and severe burns in the acute period. Therefore, we prepared guidelines intended to support the appropriate diagnosis and initial treatment for patients with burns that are commonly encountered including minor as well as moderate and severe cases. Because of this intention of the present guidelines, there is no recommendation of individual surgical procedures.
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Affiliation(s)
- Yuichiro Yoshino
- Department of Dermatology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Mikio Ohtsuka
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Masakazu Kawaguchi
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Keisuke Sakai
- Intensive Care Unit, Kumamoto University Hospital, Kumamoto, Japan
| | - Akira Hashimoto
- Department of Dermatology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Masahiro Hayashi
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Naoki Madokoro
- Department of Dermatology, Mazda Hospital, Hiroshima, Japan
| | - Yoshihide Asano
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Masatoshi Abe
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takayuki Ishii
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Taiki Isei
- Department of Dermatology, Kansai Medical University, Osaka, Japan
| | - Takaaki Ito
- Department of Dermatology, Hyogo College of Medicine, Hyogo, Japan
| | - Yuji Inoue
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinichi Imafuku
- Department of Dermatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryokichi Irisawa
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Masaki Ohtsuka
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Fumihide Ogawa
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takafumi Kadono
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tamihiro Kawakami
- Department of Dermatology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Ryuichi Kukino
- Department of Dermatology, NTT Medical Center, Tokyo, Japan
| | - Takeshi Kono
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Masanari Kodera
- Department of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Aichi, Japan
| | - Masakazu Takahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Miki Tanioka
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Nakanishi
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Minoru Hasegawa
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Hiroshi Fujiwara
- Department of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Tochigi, Japan
| | - Koma Matsuo
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Osamu Yamasaki
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | | | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Blet A, Benyamina M, Legrand M. Manifestations respiratoires précoces d’un patient brûlé grave. MEDECINE INTENSIVE REANIMATION 2015; 24:433-443. [PMID: 32288740 PMCID: PMC7117817 DOI: 10.1007/s13546-015-1084-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/08/2015] [Indexed: 11/29/2022]
Affiliation(s)
- A. Blet
- Département d’anesthésie-réanimation et centre de traitement des brûlés, AP–HP, groupe hospitalier Saint-Louis-Lariboisière, F-75010 Paris, France
- Université Paris-Diderot, F-75475 Paris, France
- UMR Inserm 942, Institut national de la santé et de la recherche médicale (Inserm), hôpital Lariboisière, F-75010 Paris, France
| | - M. Benyamina
- Département d’anesthésie-réanimation et centre de traitement des brûlés, AP–HP, groupe hospitalier Saint-Louis-Lariboisière, F-75010 Paris, France
- Université Paris-Diderot, F-75475 Paris, France
| | - M. Legrand
- Département d’anesthésie-réanimation et centre de traitement des brûlés, AP–HP, groupe hospitalier Saint-Louis-Lariboisière, F-75010 Paris, France
- Université Paris-Diderot, F-75475 Paris, France
- UMR Inserm 942, Institut national de la santé et de la recherche médicale (Inserm), hôpital Lariboisière, F-75010 Paris, France
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Bai X, Fan L, He T, Jia W, Yang L, Zhang J, Liu Y, Shi J, Su L, Hu D. SIRT1 protects rat lung tissue against severe burn-induced remote ALI by attenuating the apoptosis of PMVECs via p38 MAPK signaling. Sci Rep 2015; 5:10277. [PMID: 25992481 PMCID: PMC4445725 DOI: 10.1038/srep10277] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/08/2015] [Indexed: 12/14/2022] Open
Abstract
Silent information regulator type-1 (SIRT1) has been reported to be involved in the
cardiopulmonary protection. However, its role in the pathogenesis of burn-induced
remote acute lung injury (ALI) is currently unknown. The present study aims to
investigate the role of SIRT1 in burn-induced remote ALI and the involved signaling
pathway. We observed that SIRT1 expression in rat lung tissue after burn injury
appeared an increasing trend after a short period of suppression. The upregulation
of SIRT1 stimulated by resveratrol exhibited remission of histopathologic changes,
reduction of cell apoptosis, and downregulation of pro-inflammatory cytokines in rat
pulmonary tissues suffering from severe burn. We next used primary pulmonary
microvascular endothelial cells (PMVECs) challenged by burn serum (BS) to simulate
in vivo rat lung tissue after burn injury, and found that BS
significantly suppressed SIRT1 expression, increased cell apoptosis, and activated
p38 MAPK signaling. The use of resveratrol reversed these effects, while knockdown
of SIRT1 by shRNA further augmented BS-induced increase of cell apoptosis and
activation of p38 MAPK. Taken together, these results indicate that SIRT1 might
protect lung tissue against burn-induced remote ALI by attenuating PMVEC apoptosis
via p38 MAPK signaling, suggesting its potential therapeutic effects on the
treatment of ALI.
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Affiliation(s)
- Xiaozhi Bai
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Lei Fan
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ting He
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wenbin Jia
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Longlong Yang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jun Zhang
- Department of Burn and Plastic Surgery, No.205 Hospital of Chinese People's Liberation Army, Jinzhou, Liaoning, China
| | - Yang Liu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jihong Shi
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Linlin Su
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
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Burns to the Face, Trunk, and Extremities. Surgery 2015. [DOI: 10.1007/978-1-4939-1726-6_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Oscier C, Emerson B, Handy JM. New perspectives on airway management in acutely burned patients. Anaesthesia 2014; 69:105-10. [DOI: 10.1111/anae.12565] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Oscier
- Chelsea and Westminster NHS Foundation Trust; London UK
| | - B. Emerson
- St Andrews Centre for Plastic Surgery and Burns; Mid Essex Hospitals NHS Trust; Chelmsford UK
| | - J. M. Handy
- Chelsea and Westminster NHS Foundation Trust; London UK
- Imperial College London; London UK
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Doxycycline attenuates burn-induced microvascular hyperpermeability. J Trauma Acute Care Surg 2013; 75:1040-6; discussion 1046. [DOI: 10.1097/ta.0b013e3182aa9c79] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Palmer JL, Deburghgraeve CR, Bird MD, Hauer-Jensen M, Chen MM, Yong S, Kovacs EJ. Combined radiation and burn injury results in exaggerated early pulmonary inflammation. Radiat Res 2013; 180:276-83. [PMID: 23899376 DOI: 10.1667/rr3104.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Events such as a nuclear meltdown accident or nuclear attack have potential for severe radiation injuries. Radiation injury frequently occurs in combination with other forms of trauma, most often burns. Thus far, combined injury studies have focused mainly on skin wound healing and damage to the gut. Since both radiation exposure and remote burn have pulmonary consequences, we examined the early effects of combined injury on the lung. C57BL/6 male mice were irradiated with 5 Gy of total body irradiation followed by a 15% total body surface area scald burn. Lungs from surviving animals were examined for evidence of inflammation and pneumonitis. At 48 h post-injury, pathology of the lungs from combined injury mice showed greater inflammation compared to all other treatment groups, with marked red blood cell and leukocyte congestion of the pulmonary vasculature. There was excessive leukocyte accumulation, primarily neutrophils, in the vasculature and interstitium, with occasional cells in the alveolar space. At 24 and 48 h post-injury, myeloperoxidase levels in lungs of combined injury mice were elevated compared to all other treatment groups (P < 0.01), confirming histological evidence of neutrophil accumulation. Pulmonary levels of the neutrophil chemoattractant KC (CXCL1) were 3 times above that of either injury alone (P < 0.05). Further, monocyte chemotactic protein-1 (MCP-1, CCL2) was increased two- and threefold compared to burn injury or radiation injury, respectively (P < 0.05). Together, these data suggest that combined radiation and burn injury augments early pulmonary congestion and inflammation. Currently, countermeasures for this unique type of injury are extremely limited. Further research is needed to elucidate the mechanisms behind the synergistic effects of combined injury in order to develop appropriate treatments.
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Affiliation(s)
- Jessica L Palmer
- a Burn and Shock Trauma Institute, Department of Surgery, and Loyola University Medical Center, Maywood, Illinois 60153
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Ulinastatin suppresses burn-induced lipid peroxidation and reduces fluid requirements in a Swine model. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2013; 2013:904370. [PMID: 23738046 PMCID: PMC3655655 DOI: 10.1155/2013/904370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/06/2013] [Accepted: 04/08/2013] [Indexed: 12/02/2022]
Abstract
Objective. Lipid peroxidation plays a critical role in burn-induced plasma leakage, and ulinastatin has been reported to reduce lipid peroxidation in various models. This study aims to examine whether ulinastatin reduces fluid requirements through inhibition of lipid peroxidation in a swine burn model. Methods. Forty miniature swine were subjected to 40% TBSA burns and were randomly allocated to the following four groups: immediate lactated Ringer's resuscitation (ILR), immediate LR containing ulinastatin (ILR/ULI), delayed LR resuscitation (DLR), and delayed LR containing ulinastatin (DLR/ULI). Hemodynamic variables, net fluid accumulation, and plasma thiobarbituric acid reactive substances (TBARS) concentrations were measured. Heart, liver, lung, skeletal muscle, and ileum were harvested at 48 hours after burn for evaluation of TBARS concentrations, activities of antioxidant enzymes, and tissue water content. Results. Ulinastatin significantly reduced pulmonary vascular permeability index (PVPI) and extravascular lung water index (ELWI), net fluid accumulation, and water content of heart, lung, and ileum in both immediate or delayed resuscitation groups. Furthermore, ulinastatin infusion significantly reduced plasma and tissue concentrations of TBARS in both immediate or delayed resuscitation groups. Conclusions. These results indicate that ulinastatin can reduce fluid requirements through inhibition of lipid peroxidation.
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36
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Preemptive Use of High-Frequency Oscillatory Ventilation in Pediatric Burn Patients. J Burn Care Res 2013; 34:237-42. [DOI: 10.1097/bcr.0b013e31826fc5fa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Daviaud F, Bouglé A, Cariou A. Chocs d’allure septique. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-012-0542-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wang G, Zhang BQ, Ruan J, Luo ZH, Zhang JP, Xiao R, Lei ZY, Hu JY, Chen YS, Huang YS. Shaking stress aggravates burn-induced cardiovascular and renal disturbances in a rabbit model. Burns 2012; 39:760-6. [PMID: 23063799 DOI: 10.1016/j.burns.2012.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 09/05/2012] [Accepted: 09/05/2012] [Indexed: 01/01/2023]
Abstract
The aim of this study was to address the effects of shaking stress (a.k.a. physical agitation) on burn-induced remote organ injury and to evaluate the application of delayed fluid resuscitation to treat severe burns under shaking conditions. Healthy adult male rabbits, weighing 2.50±0.40 kg, were randomly assigned to the following groups: control group, burn group, and burn+shaking group. One half of burned animals received a 6-h delayed fluid resuscitation and the other half remained untreated. Cardiovascular hemodynamics and functional and pathological changes of the heart and kidney were examined. Compared to normal controls, untreated burned animals showed decreased hemodynamic parameters, increased serum lactic acid, and severe myocardial inflammation. The burn-induced hemodynamic abnormalities and cardiac injury were aggravated by shaking stress. Burn injury led to reduced urine volume, elevated serum creatinine and blood urea nitrogen, and formation of erythrocyte casts in renal tubules. Shaking stimulation worsened the burn-associated functional and pathological changes of the kidney. Fluid resuscitation markedly mitigated cardiac and renal injury in burned animals, and, to a lesser extent, in the presence of shaking stimulation. Shaking stimulation aggravates burn-induced cardiovascular and renal disturbances. Delayed fluid resuscitation attenuates cardiac and renal damages in burn injury under shaking conditions.
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Affiliation(s)
- Guang Wang
- Institute of Burn Research of PLA, National Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
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Maani CV, Hansen JJ, Fortner PA, Cancio LC, DeSocio PA. Perioperative Anesthetic Considerations for Burn Patients. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.cpen.2011.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kasten KR, Makley AT, Kagan RJ. Update on the critical care management of severe burns. J Intensive Care Med 2011; 26:223-36. [PMID: 21764766 DOI: 10.1177/0885066610390869] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Care of the severely injured patient with burn requires correct diagnosis, appropriately tailored resuscitation, and definitive surgical management to reduce morbidity and mortality. Currently, mortality rates related to severe burn injuries continue to steadily decline due to the standardization of a multidisciplinary approach instituted at tertiary health care centers. Prompt and accurate diagnoses of burn wounds utilizing Lund-Browder diagrams allow for appropriate operative and nonoperative management. Coupled with diagnostic improvements, advances in resuscitation strategies involving rates, volumes, and fluid types have yielded demonstrable benefits related to all aspects of burn care. More recently, identification of comorbid conditions such as inhalation injury and malnutrition have produced appropriate protocols that aid the healing process in severely injured patients with burn. As more patients survive larger burn injuries, the early diagnosis and successful treatment of secondary and tertiary complications are becoming commonplace. While advances in this area are exciting, much work to elucidate immune pathways, diagnostic tests, and effective treatment regimens still remain. This review will provide an update on the critical care management of severe burns, touching on accurate diagnosis, resuscitation, and acute management of this difficult patient population.
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Affiliation(s)
- Kevin R Kasten
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45229, USA
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41
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Mullally C, Carey K, Seshadri R. Use of a nanocrystalline silver dressing and vacuum-assisted closure in a severely burned dog. J Vet Emerg Crit Care (San Antonio) 2011; 20:456-63. [PMID: 20731813 DOI: 10.1111/j.1476-4431.2010.00564.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the first veterinary use of a nanocrystalline silver dressing (NSD) and use of vacuum-assisted closure (VAC) to treat a severely burned dog. CASE OR SERIES SUMMARY A 1-year-old female intact American Staffordshire Terrier with 50% total body surface area burned was referred for definitive care approximately 18-24 hours post injury. The dog was treated with crystalloid fluids, hydroxyethyl starch, and antimicrobials based on culture and sensitivity results of wound cultures, fresh frozen plasma, human serum albumin, and packed red cells. Wound care initially consisted of daily debridement under anesthesia with silver sulfadiazine application and bandaging. Because of the extent and the location of the wounds and morbid state of the patient, early wound grafting was not an option. Because of its reported improvement in granulation tissue formation and decreased tissue edema, VAC was used once the majority of burned tissue was manually debrided. Because of the pain caused by VAC and traditional bandaging techniques with this extent of injury, an NSD was utilized. This strategy was chosen due to the antimicrobial properties of NSD and the reduced necessity for daily bandage changes, which was reduced to only every 3 days. This protocol reduced the need for daily sedation or anesthesia. NEW OR UNIQUE INFORMATION PROVIDED VAC and NSD were used successfully for the treatment of a severe burn injury in a dog. The use of NSD decreased the cost of therapy by reducing the need for daily bandage changes, thereby reducing the anesthetic and analgesic costs and allowing the patient to be managed on an outpatient basis.
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Affiliation(s)
- Colleen Mullally
- Advanced Critical Care, City of Angels Veterinary Specialty Center, Culver City, CA 90232, USA.
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Sio SWS, Moochhala S, Lu J, Bhatia M. Early protection from burn-induced acute lung injury by deletion of preprotachykinin-A gene. Am J Respir Crit Care Med 2010; 181:36-46. [PMID: 19797759 DOI: 10.1164/rccm.200907-1073oc] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Burn-induced acute lung injury (ALI) is a common clinical disorder associated with high mortality even in the absence of inhalational injury. Identification of endogenous triggers that mediate the early onset of remote ALI after burn represents an important goal but remains poorly defined. OBJECTIVES We investigated the role of proinflammatory neuropeptide, substance P (SP), in instigating remote ALI and its effects on respiratory function early after severe local burn injury. METHODS A 30% total body surface area full-thickness burn was induced in wild-type (WT) mice, preprotachykinin-A (PPT-A) gene deficient mice, which encodes for SP, and PPT-A(-/-) mice challenged with exogenous SP, followed by ALI and lung function analysis. MEASUREMENTS AND MAIN RESULTS Endogenous SP production was heightened in burn-injured WT mice, which induced significant elevation of proinflammatory cytokines, chemokines, and endothelial adhesion molecules concurrent with disruption of pulmonary permeability barrier, excessive neutrophil infiltration, and severe ALI. Additionally, decreased neutral endopeptidase and elevated matrix metalloproteinase-9 were evident. Notably, disruption of respiratory function demonstrates a critical role of SP in lungs after burn. These effects were significantly attenuated in PPT-A(-/-) mice, whereas the exogenous administration of SP to PPT-A(-/-) mice restored the inflammatory response and ALI. Furthermore, analysis of neurokinin-1-receptor (NK1R), to which SP binds preferentially, revealed that SP in conjunction with burn injury regulates NK1R expression. CONCLUSIONS We show that the absence of a single endogenous factor, SP, significantly provides early protection against burn-induced ALI in mice with marked improvement in respiratory function. Thereby, the blockade of SP may be beneficial in preventing early inflammation and ALI in patients with critical burn injuries.
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Affiliation(s)
- Selena W S Sio
- Department of Pharmacology, National University of Singapore, Singapore
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Kai-Yang L, Shi-Hui Z, Hong-Tai T, Yi-Tao J, Zhao-Fan X, Dao-Feng B, Wei L, Guang-Qing W, Guang-Yi W, Shi-Chu X, Da-Sheng C, Bing M, Jian-Rong Z. The direct hospitalisation costs of paediatric scalds: 2-Year results of a prospective case series. Burns 2009; 35:738-45. [DOI: 10.1016/j.burns.2008.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 11/20/2008] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
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Meyerholz DK, Piester TL, Sokolich JC, Zamba GKD, Light TD. Morphological parameters for assessment of burn severity in an acute burn injury rat model. Int J Exp Pathol 2009; 90:26-33. [PMID: 19200248 DOI: 10.1111/j.1365-2613.2008.00617.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Determination of burn severity (i.e. burn depth) is important for effective medical management and treatment. Using a recently described acute burn model, we studied various morphological parameters to detect burn severity. Anaesthetized Sprague-Dawley rats received burns of various severity (0- to 14-s contact time) followed by standard resuscitation using intravenous fluids. Biopsies were taken from each site after 5 h, tissues fixed in 10% neutral-buffered formalin, processed and stained with haematoxylin and eosin. Superficial burn changes in the epidermis included early keratinocyte swelling progressing to epidermal thinning and nuclear elongation in deeper burns. Subepidermal vesicle formation generally decreased with deeper burns and typically contained grey foamy fluid. Dermal burns were typified by hyalinized collagen and a lack of detectable individual collagen fibres on a background of grey to pale eosinophilic seroproteinaceous fluid. Intact vascular structures were identified principally deep to the burn area in the collagen. Follicle cell injury was identified by cytoplasmic clearing/swelling and nuclear pyknosis, and these follicular changes were often the deepest evidence of burn injury seen for each time point. Histological scores (epidermal changes) or dermal parameter depths (dermal changes) were regressed on burn contact time. Collagen alteration (r(2) = 0.91) correlated best to burn severity followed by vascular patency (r(2) = 0.82), epidermal changes (r(2) = 0.76), subepidermal vesicle formation (r(2) = 0.74) and follicular cell injury was useful in all but deep burns. This study confirms key morphological parameters can be an important tool for the detection of burn severity in this acute burn model.
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Affiliation(s)
- David K Meyerholz
- Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA.
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Abstract
Major burn injury remains a significant cause of morbidity and mortality in pediatric patients. With advances in burn care and with the development of experienced multi-disciplinary teams at regionalized burn centers, many children are surviving severe burn injury. As members of the multi-disciplinary care team, anesthesia providers are called upon to care for these critically ill children. These children provide several anesthetic challenges, such as difficult airways, difficult vascular access, fluid and electrolyte imbalances, altered temperature regulation, sepsis, cardiovascular instability, and increased requirements of muscle relaxants and opioids. The anesthesia provider must understand the physiologic derangements that occur with severe burn injury as well as the subsequent anesthetic implications.
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Affiliation(s)
- Gennadiy Fuzaylov
- Department of Anesthesia and Critical Care, Pediatric Anesthesia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Trupkovic T, Giessler G. [Burn trauma. Part 1: pathophysiology, preclinical care and emergency room management]. Anaesthesist 2009; 57:898-907. [PMID: 18716752 DOI: 10.1007/s00101-008-1428-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Severe burn injuries are rare and represent less than 1% of all medical emergencies. At the scene of the accident self-protection is important. The progress of thermal injury should be stopped, while cold water therapy is usually not indicated as the resulting hypothermia severely reduces the prognosis. A thorough body check reveals the burn size, depth and presence of co-injuries. Volume depletion is the main pathophysiological reason for burn shock. Early infusion therapy is of prognostic significance. Sufficient analgesia has to be established. Intubation is not generally indicated even with extensive burns, whereas early intubation can be life-saving in the case of circular thoracic burns, face burns and inhalation trauma. Local or systemic administration of corticosteroids is not indicated. Transfer to a specialized burn unit depends on burn size and depth. Emergency room management includes stabilization of vital functions, evaluation of co-injuries and initiation of the specific surgical and intensive care therapy.
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Affiliation(s)
- T Trupkovic
- Abteilung für Anästhesie, Intensivmedizin und Schmerztherapie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen.
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Development and validation of a model for prediction of mortality in patients with acute burn injury. Br J Surg 2009; 96:111-7. [PMID: 19109825 DOI: 10.1002/bjs.6329] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The objective was to develop a user-friendly model to predict the probability of death from acute burns soon after injury, based on burned surface area, age and presence of inhalation injury. METHODS This population-based cohort study included all burned patients admitted to one of the six Belgian burn centres. Data from 1999 to 2003 (5246 patients) were used to develop a mortality prediction model, and data from 2004 (981 patients) were used for validation. RESULTS Mortality in the derivation cohort was 4.6 per cent. A mortality score (0-10 points) was devised: 0-4 points according to the percentage of burned surface area (less than 20, 20-39, 40-59, 60-79 or at least 80 per cent), 0-3 points according to age (under 50, 50-64, 65-79 or at least 80 years) and 3 points for the presence of an inhalation injury. Mortality in the validation cohort was 4.3 per cent. The model predicted 40 deaths, and 42 deaths were observed (P = 0.950). Receiver-operator characteristic curve analysis of the model for prediction of mortality demonstrated an area under the curve of 0.94 (95 per cent confidence interval 0.90 to 0.97). CONCLUSION An accurate model was developed to predict the probability of death from acute burn injury based on simple and objective clinical criteria.
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Bloemsma GC, Dokter J, Boxma H, Oen IMMH. Mortality and causes of death in a burn centre. Burns 2008; 34:1103-7. [PMID: 18538932 DOI: 10.1016/j.burns.2008.02.010] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 02/14/2008] [Indexed: 11/16/2022]
Affiliation(s)
- G C Bloemsma
- Rotterdam Burn Centre, Department of Surgery, Medisch Centrum Rijnmond Zuid, 315 Groene Hilledijk, 3075 EA, Rotterdam, Netherlands.
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Galeiras R, Lorente JA, Pértega S, Vallejo A, Tomicic V, de la Cal MA, Pita S, Cerdá E, Esteban A. A model for predicting mortality among critically ill burn victims. Burns 2008; 35:201-9. [PMID: 19019556 DOI: 10.1016/j.burns.2008.07.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 07/07/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop a model for predicting mortality among burn victims. METHODS All casualties admitted to our intensive care burn unit (ICBU) with a diagnosis of thermal or inhalation injury were studied. Age, total and full-thickness body surface area (BSA) burned, presence of inhalation injury, gender, mechanism of injury, delay to ICBU admission and mechanical ventilation during the first 72 h were recorded. The 851 participants were randomly divided into derivation (671) and validation (180) sets. From univariate and multivariate logistic regression analyses a mortality predictive equation was derived. RESULTS Mortality was 17.6%. In univariate analysis, all variables were significantly associated with mortality except mechanism of injury and delay to ICBU admission. In multivariate analysis, age, total and full-thickness BSA burned, female gender and early mechanical ventilation were independently associated with mortality. CONCLUSIONS We propose a mortality predictive equation for burned victims. In this model, MV and not inhalation injury is a mortality risk factor.
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Yurt RW. Burns and Inhalation Injury. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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