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Tejiram S, Tranchina SP, Travis TE, Shupp JW. The First 24 Hours: Burn Shock Resuscitation and Early Complications. Surg Clin North Am 2023; 103:403-413. [PMID: 37149377 DOI: 10.1016/j.suc.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Resuscitation is required for the management of patients with severe thermal injury. Some of the initial pathophysiologic events following burn injury include an exaggerated inflammatory state, injury to the endothelium, and increased capillary permeability, which all culminate in shock. Understanding these processes is critical to the effective management of patients with burn injuries. Formulas predicting fluid requirements during burn resuscitation have evolved over the past century in response to clinical experience and research efforts. Modern resuscitation features individualized fluid titration and monitoring along with colloid-based adjuncts. Despite these developments, complications from over-resuscitation still occur.
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Affiliation(s)
- Shawn Tejiram
- The Burn Center, MedStar Washington Hospital Center, 110 Irving Street, Northwest Suite 3B-55, Washington, DC 20010, USA; Department of Surgery, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA
| | - Stephen P Tranchina
- Georgetown University School, 3900 Reservoir Road NW, Washington, DC 20007, USA
| | - Taryn E Travis
- The Burn Center, MedStar Washington Hospital Center, 110 Irving Street, Northwest Suite 3B-55, Washington, DC 20010, USA; Department of Surgery, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA
| | - Jeffrey W Shupp
- The Burn Center, MedStar Washington Hospital Center, 110 Irving Street, Northwest Suite 3B-55, Washington, DC 20010, USA; Department of Surgery, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA; Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA; Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, 37th and O Street, Northwest, Washington, DC 20057, USA.
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Strong B, Spoors C, Richardson N, Martin N, Barnes D, El-Muttardi N, Shelley O. Abdominal compartment syndrome in burns patients: Introduction of an evidence-based management guideline and algorithm. J Trauma Acute Care Surg 2021; 90:e146-e154. [PMID: 34016932 DOI: 10.1097/ta.0000000000003131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Abdominal compartment syndrome is a serious potential complication of burn injury, and carries high morbidity and mortality. Although there are generalised published guidelines on managing the condition, to date no management algorithm has yet been published tailored specifically to the burn injury patient. We set out to examine the literature on the subject in order to produce an evidence based management guideline, with the aim of improving outcomes for these patients. The guideline covers early detection and assessment of the condition as well as optimum medical, surgical and postoperative management. We believe that this guideline provides a much needed benchmark for managing burns patients with raised intra-abdominal pressure, as well as providing a template for further research and improvements in care.
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Affiliation(s)
- Ben Strong
- From the St Andrews Centre for Plastic Surgery and Burns (B.S., C.S., N.M., D.B., N.E.-M., O.S.), Broomfield Hospital; and Department of Surgery (N.R.), Broomfield Hospital, Chelmsford, United Kingdom
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Abstract
The objective of this article is to investigate adherence to reporting standards and methodological quality in systematic reviews on burns care published in peer-reviewed journals to determine their utility for guiding evidence-based burns care. PubMed, Embase, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, and the Joanna Briggs Institute (JBI) Database of Systematic Reviews and Implementation Reports were searched from 2009. Any systematic review on any question on therapeutic interventions in burns care was eligible for inclusion. Critical appraisal and data extraction were performed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist by two independent reviewers. The overall quality of the 44 included burns care systematic reviews was low, with an average methodological quality of 55% and an average compliance with reporting guidelines of 70%. Correlation analysis showed that adherence to reporting guidelines has been relatively stable, but methodological quality has deteriorated (r = -.32, P < .05). Cochrane reviews had lower citation rates than reviews published in other journals, whereas reviews that included meta-analyses had more citations. Quality did not have a significant effect on citation rate. Health professionals working in burns should be able to expect that systematic reviews published in their field are of a high standard. Unfortunately, this is not the case. To address this problem, established guidelines on the conduct and reporting of systematic reviews should be adhered to by researchers and editors.
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Huang M, Chen JF, Chen LY, Pan LQ, Li XJ, Ye JY, Tan HY. A comparison of two different fluid resuscitation management protocols for pediatric burn patients: A retrospective study. Burns 2017; 44:82-89. [PMID: 29229195 DOI: 10.1016/j.burns.2017.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/20/2017] [Accepted: 07/10/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Pediatric burn patients are more susceptible to burn shock than adults, and an effective fluid management protocol is critical to successful resuscitation. Our research aim was to investigate the safety and efficacy of two protocols for pediatric burn patients for use within the first 24h. METHODS A total of 113 pediatric burn patients were enrolled from January 2007 to October 2012. Of those patients, 57 received fluid titration regimens of alternating crystalloids and colloids once within 2h in the first 24h after burn (Group A), whereas the remaining patients received regimens of alternating crystalloids and colloids once within 1h in the first 24h after burn (Group B). The safety, fluid volume infused and urine output were recorded and compared. RESULTS All the patients survived in the first 24h after burn. There were no significant differences between Group A and Group B in lactic acid (LA) level and base excess (BE). The water infused in Group A were greater than that of Group B in the first 24h (P=0.024). No significant differences were found in total volume intake and hourly urine output between the 2 groups in the first 24h. CONCLUSION The implementation of fluid resuscitation using either protocol A or protocol B is safe and effective for pediatric burn patients in the first 24h. The total fluid infused were similar between two protocols. But using protocol A may be more convenient and labor-saving for nurses.
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Affiliation(s)
- Miao Huang
- Department of Nursing, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, 510220, China
| | - Jun-Feng Chen
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Ministry of Education, Guangzhou, 510630, China
| | - Li-Ying Chen
- Department of Burns, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, 510220, China
| | - Li-Qin Pan
- Department of Burns, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, 510220, China
| | - Xiao-Jian Li
- Department of Burns, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, 510220, China
| | - Jie-Yu Ye
- Department of Burns, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, 510220, China
| | - Hui-Yi Tan
- Department of Nursing, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, 510220, China.
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Wasiak J, Tyack Z, Ware R, Goodwin N, Faggion CM. Poor methodological quality and reporting standards of systematic reviews in burn care management. Int Wound J 2017; 14:754-763. [PMID: 27990772 PMCID: PMC7949759 DOI: 10.1111/iwj.12692] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/02/2016] [Indexed: 12/18/2022] Open
Abstract
The methodological and reporting quality of burn-specific systematic reviews has not been established. The aim of this study was to evaluate the methodological quality of systematic reviews in burn care management. Computerised searches were performed in Ovid MEDLINE, Ovid EMBASE and The Cochrane Library through to February 2016 for systematic reviews relevant to burn care using medical subject and free-text terms such as 'burn', 'systematic review' or 'meta-analysis'. Additional studies were identified by hand-searching five discipline-specific journals. Two authors independently screened papers, extracted and evaluated methodological quality using the 11-item A Measurement Tool to Assess Systematic Reviews (AMSTAR) tool and reporting quality using the 27-item Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Characteristics of systematic reviews associated with methodological and reporting quality were identified. Descriptive statistics and linear regression identified features associated with improved methodological quality. A total of 60 systematic reviews met the inclusion criteria. Six of the 11 AMSTAR items reporting on 'a priori' design, duplicate study selection, grey literature, included/excluded studies, publication bias and conflict of interest were reported in less than 50% of the systematic reviews. Of the 27 items listed for PRISMA, 13 items reporting on introduction, methods, results and the discussion were addressed in less than 50% of systematic reviews. Multivariable analyses showed that systematic reviews associated with higher methodological or reporting quality incorporated a meta-analysis (AMSTAR regression coefficient 2.1; 95% CI: 1.1, 3.1; PRISMA regression coefficient 6·3; 95% CI: 3·8, 8·7) were published in the Cochrane library (AMSTAR regression coefficient 2·9; 95% CI: 1·6, 4·2; PRISMA regression coefficient 6·1; 95% CI: 3·1, 9·2) and included a randomised control trial (AMSTAR regression coefficient 1·4; 95%CI: 0·4, 2·4; PRISMA regression coefficient 3·4; 95% CI: 0·9, 5·8). The methodological and reporting quality of systematic reviews in burn care requires further improvement with stricter adherence by authors to the PRISMA checklist and AMSTAR tool.
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Affiliation(s)
- Jason Wasiak
- Epworth HealthCareRichmondVAAustralia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Children's Health Research CentreThe University of Queensland & Centre for Functioning and Health Research Metro South HealthBrisbaneQLDAustralia
| | - Robert Ware
- Menzies Health Institute QueenslandGriffith UniversityBrisbaneQLDAustralia
| | | | - Clovis M Faggion
- Department of Periodontology and Restorative Dentistry, Faculty of DentistryUniversity of MunsterMunsterGermany
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Jones LM, Deluga N, Bhatti P, Scrape SR, Bailey JK, Coffey RA. TRALI following fresh frozen plasma resuscitation from burn shock. Burns 2016; 43:397-402. [PMID: 28029475 DOI: 10.1016/j.burns.2016.08.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/11/2016] [Accepted: 08/22/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Resuscitation from burn shock using fresh frozen plasma (FFP) has been described. Critics of FFP resuscitation cite the development of transfusion related acute lung injury (TRALI) as a deterrent to its use. This study examines the occurrence of TRALI with FFP resuscitation of critically ill burned patients. METHODS A retrospective chart review was conducted of severely burned patients who received FFP resuscitation. Data points included age, TBSA, TBSA full thickness, presence of alternate etiologies of acute lung injury, total FFP administered, and signs and symptoms of TRALI as defined per the Canadian Blood Services Consensus Conference. RESULTS Eighty-three patients met the definition of severe burn and received FFP resuscitation. Of those, 65 met exclusion criteria. Eighteen patients were left for analysis with only one found to have signs and symptoms of TRALI. That patient suffered a 53.5% TBSA burn, received a total of 6228ml FFP, had no competing etiologies of ALI, and was diagnosed with TRALI within 6h of completing the FFP transfusion. CONCLUSION The possible occurrence of TRALI in burn patients receiving FFP resuscitation should be weighed against the reported benefits of such a resuscitation strategy.
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Affiliation(s)
- Larry M Jones
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
| | - Nicholas Deluga
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA.
| | | | - Scott R Scrape
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
| | - John K Bailey
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
| | - Rebecca A Coffey
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
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Azzopardi EA, Conlan RS, Whitaker IS. Polymer therapeutics in surgery: the next frontier. ACTA ACUST UNITED AC 2016; 1:19-29. [PMID: 27588210 PMCID: PMC4985703 DOI: 10.1002/jin2.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/18/2015] [Accepted: 11/20/2015] [Indexed: 01/13/2023]
Abstract
Polymer therapeutics is a successful branch of nanomedicine, which is now established in several facets of everyday practice. However, to our knowledge, no literature regarding the application of the underpinning principles, general safety, and potential of this versatile class to the perioperative patient has been published. This study provides an overview of polymer therapeutics applied to clinical surgery, including the evolution of this demand‐oriented scientific field, cutting‐edge concepts, its implications, and limitations, illustrated by products already in clinical use and promising ones in development. In particular, the effect of design of polymer therapeutics on biophysical and biochemical properties, the potential for targeted delivery, smart release, and safety are addressed. Emphasis is made on principles, giving examples in salient areas of demand in current surgical practice. Exposure of the practising surgeon to this versatile class is crucial to evaluate and maximise the benefits that this established field presents and to attract a new generation of clinician–scientists with the necessary knowledge mix to drive highly successful innovation.
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Affiliation(s)
- Ernest A Azzopardi
- Reconstructive Surgery and Regenerative Medicine Research Unit, Institute for Life Science Swansea University Medical School, Swansea University Singleton Park Campus SwanseaSA2 8PP UK; The Welsh Centre for Burns and Plastic Surgery Moriston Hospital Swansea Swansea SA6 6NL UK; Institute for Life Science and Centre for NanoHealth Swansea University Medical School, Swansea University Singleton Park Campus Swansea SA2 8PP UK
| | - R Steven Conlan
- Institute for Life Science and Centre for NanoHealth Swansea University Medical School, Swansea University Singleton Park Campus Swansea SA2 8PP UK
| | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Unit, Institute for Life Science Swansea University Medical School, Swansea University Singleton Park Campus SwanseaSA2 8PP UK; The Welsh Centre for Burns and Plastic Surgery Moriston Hospital Swansea Swansea SA6 6NL UK; Institute for Life Science and Centre for NanoHealth Swansea University Medical School, Swansea University Singleton Park Campus Swansea SA2 8PP UK
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Guilabert P, Usúa G, Martín N, Abarca L, Barret JP, Colomina MJ. Fluid resuscitation management in patients with burns: update. Br J Anaesth 2016; 117:284-96. [PMID: 27543523 DOI: 10.1093/bja/aew266] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Since 1968, when Baxter and Shires developed the Parkland formula, little progress has been made in the field of fluid therapy for burn resuscitation, despite advances in haemodynamic monitoring, establishment of the 'goal-directed therapy' concept, and the development of new colloid and crystalloid solutions. Burn patients receive a larger amount of fluids in the first hours than any other trauma patients. Initial resuscitation is based on crystalloids because of the increased capillary permeability occurring during the first 24 h. After that time, some colloids, but not all, are accepted. Since the emergence of the Pharmacovigilance Risk Assessment Committee alert from the European Medicines Agency concerning hydroxyethyl starches, solutions containing this component are not recommended for burns. But the question is: what do we really know about fluid resuscitation in burns? To provide an answer, we carried out a non-systematic review to clarify how to quantify the amount of fluids needed, what the current evidence says about the available solutions, and which solution is the most appropriate for burn patients based on the available knowledge.
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Affiliation(s)
| | - G Usúa
- Anesthesia and Critical Care Department
| | - N Martín
- Anesthesia and Critical Care Department
| | - L Abarca
- Anesthesia and Critical Care Department
| | - J P Barret
- Plastic Surgery Department and Burn Centre, Hospital Universitari Vall d'Hebron, Barcelona 08035, Spain
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Chang M, Li Y, Liu D, Zhang L, Zhang H, Tang H, Zhang H. Melatonin prevents secondary intra-abdominal hypertension in rats possibly through inhibition of the p38 MAPK pathway. Free Radic Biol Med 2016; 97:192-203. [PMID: 27264238 DOI: 10.1016/j.freeradbiomed.2016.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 01/30/2023]
Abstract
Exogenous administration of melatonin has been demonstrated to down-regulate inflammatory responses and attenuate organ damage in various models. However, the salutary effect of melatonin against secondary intra-abdominal hypertension (IAH) remains unclear. This study sought to test the influence of melatonin on secondary IAH in a pathophysiological rat model and the underlying mechanisms involved. Before resuscitation, male rats underwent a combination of induced portal hypertension, applying an abdominal restraint device, and hemorrhaging to mean arterial pressure (MAP) of 40mmHg for 2h. After blood reinfusion, the rats were treated with lactated Ringer solution (LR) (30mL/h), melatonin (50mg/kg) +LR, and SB-203580 (10μmol/kg)+LR. LR was continuously infused for 6h. MAP, the inferior vena cava pressure and urine output were monitored. Histopathological examination, immunofluorescence of tight junction proteins, and transmission electron microscopy were administered. Intestinal permeability, myeloperoxidase activity, malondialdehyde, glutathione peroxidase, and levels of TNF-a, IL-2, and IL-6, were assessed. The expression of extracellular signal-regulated kinase, p38, c-Jun NH2-terminal kinase, translocation of nuclear factor kappa B subunit, signal transducers and activators of transcription and tight junction proteins were detected by Western blot. We found that melatonin inhibited the inflammatory responses, decreased expression of p38 MAPK, attenuated intestinal injury, and prevented secondary IAH. Moreover, administration of SB203580 abolished the increase in p38 MAPK and also attenuated intestinal injury. These data indicate that melatonin exerts a protective effect in intestine in secondary IAH primarily by attenuating the inflammatory responses which are in part attributable to p38 MAPK inhibition.
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Affiliation(s)
- Mingtao Chang
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yang Li
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Dong Liu
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Lianyang Zhang
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China.
| | - Hongguang Zhang
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Hao Tang
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Huayu Zhang
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
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Henschke A, Lee R, Delaney A. Burns management in ICU: Quality of the evidence: A systematic review. Burns 2016; 42:1173-82. [PMID: 27268108 DOI: 10.1016/j.burns.2016.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/23/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The objective of this study was to assess the quality of readily available evidence regarding critical care aspects of the management of patients with severe burn injuries. METHOD PUBMED, EMBASE, Cochrane Databases and bibliographies of included studies and burns review articles were searched from inception of databases to end of February 2015. We included systematic reviews, randomised controlled trials (RCTs) and cohort studies with concurrent controls on the topics of (a) fluid resuscitation (b) analgesia (c) haemodynamic monitoring and targets (d) ventilation (e) blood transfusion. The quality of the studies was assessed using validated tools. RESULTS Fifty six studies fulfilled the inclusion criteria. Twenty three on fluid resuscitation, 22 on analgesia, nine on haemodynamic monitoring and two on ventilation. No studies were found on blood transfusion practice. There were ten systematic reviews, 38 RCTs and eight cohort studies with concurrent controls. The majority of studies were single centre trials with small numbers of patients, surrogate outcomes and high risk of bias. CONCLUSIONS There is very little high quality evidence to guide clinical practice in early management of the severely burnt patient. Eleven of 56 studies found in our search of critical care topics were of good methodological quality with low risk of bias.
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Affiliation(s)
- Alice Henschke
- Intensive Care Unit, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
| | - Richard Lee
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Anthony Delaney
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
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The effect of the abdominal perfusion pressure on visceral circulation in critically ill patients with multiorgan dysfunction. THE EGYPTIAN JOURNAL OF CRITICAL CARE MEDICINE 2015. [DOI: 10.1016/j.ejccm.2015.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Controversy remains over appropriate endpoints of resuscitation during fluid resuscitation in early burns management. We reviewed the evidence as to whether utilizing alternative endpoints to hourly urine output produces improved outcomes. MEDLINE, CINAHL, EMBASE, Cochrane Library, Web of Science, and full-text clinicians' health journals at OVID, from 1990 to January 2014, were searched with no language restrictions. The keywords burns AND fluid resuscitation AND monitoring and related synonyms were used. Outcomes of interest included all-cause mortality, organ dysfunction, length of stay (hospital, intensive care), time on mechanical ventilation, and complications such as incidence of pulmonary edema, compartment syndromes, and infection. From 482 screened, eight empirical articles, 11 descriptive studies, and one systematic review met the criteria. Utilization of hemodynamic monitoring compared with hourly urine output as an endpoint to guide resuscitation found an increased survival (risk ratio [RR], 0.58; 95% confidence interval, 0.42-0.85; P < 0.004), with no effect on renal failure (RR, 0.77; 95% confidence interval, 0.39-1.43; P = 0.38). However, inclusion of the randomized controlled trials only found no survival advantage of hemodynamic monitoring over hourly urine output (RR, 0.72; 95% confidence interval, 0.43-1.19; P = 0.19) for mortality. There were conflicting findings between studies for the volume of resuscitation fluid, incidence of sepsis, and length of stay. There is limited evidence of increased benefit with utilization of hemodynamic monitoring, however, all studies lacked assessor blinding. A large multicenter study with a priori-determined subgroup analysis investigating alternative endpoints of resuscitation is warranted.
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14
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Melatonin inhibits thermal injury–induced hyperpermeability in microvascular endothelial cells. J Trauma Acute Care Surg 2014; 77:899-905; discussion 905. [DOI: 10.1097/ta.0000000000000346] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Coetzee A, Dyer RA, James MFM, Joubert IA, Levin A, Piercy J, Swanevelder J, Van der Merwe W. Evidence-based approach to the use of starch-containing intravenous fluids: an official response by two Western Cape University Hospitals. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2013.10872922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A Coetzee
- 1Department of Anesthesiology and Critical Care, University of Stellenbosch and Tygerberg Hospital
| | - RA Dyer
- 2Department of Anaesthesia, University of Cape Town and Groote Schuur Hospital
| | - MFM James
- 2Department of Anaesthesia, University of Cape Town and Groote Schuur Hospital
| | - IA Joubert
- 3Department of Critical Care, University of Cape Town and Groote Schuur Hospital Authors in alphabetical order
| | - A Levin
- 1Department of Anesthesiology and Critical Care, University of Stellenbosch and Tygerberg Hospital
| | - J Piercy
- 3Department of Critical Care, University of Cape Town and Groote Schuur Hospital Authors in alphabetical order
| | - J Swanevelder
- 2Department of Anaesthesia, University of Cape Town and Groote Schuur Hospital
| | - W Van der Merwe
- 1Department of Anesthesiology and Critical Care, University of Stellenbosch and Tygerberg Hospital
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James MFM. Volume therapy in trauma and neurotrauma. Best Pract Res Clin Anaesthesiol 2014; 28:285-96. [PMID: 25208963 DOI: 10.1016/j.bpa.2014.06.005] [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: 05/20/2014] [Revised: 06/25/2014] [Accepted: 06/27/2014] [Indexed: 11/30/2022]
Abstract
Volume therapy in trauma should be directed at the restitution of disordered physiology including volume replacement to re-establishment of tissue perfusion, correction of coagulation deficits and avoidance of fluid overload. Recent literature has emphasised the importance of damage control resuscitation, focussing on the restoration of normal coagulation through increased use of blood products including fresh frozen plasma, platelets and cryoprecipitate. However, once these targets have been met, and in patients not in need of damage control resuscitation, clear fluid volume replacement remains essential. Such volume therapy should include a balance of crystalloids and colloids. Pre-hospital resuscitation should be limited to that required to sustain a palpable radial artery and adequate mentation. Neurotrauma patients require special consideration in both pre-hospital and in-hospital management.
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Affiliation(s)
- M F M James
- Department of Anaesthesia, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape 7925, South Africa.
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Abstract
Abdominal compartment syndrome (ACS) is a lethal complication of acute pancreatitis. We performed a systematic review to assess the treatment and outcome of these patients.A systematic literature search for cohorts of patients with acute pancreatitis and ACS was performed. The main outcomes were number of patients with ACS, radiologic and surgical interventions, morbidity, mortality, and methodological quality.After screening 169 articles, 7 studies were included. Three studies were prospective and 4 studies were retrospective. The overall methodological quality of the studies was moderate to low. The pooled data consisted of 271 patients, of whom 103 (38%) developed ACS. Percutaneous drainage of intraabdominal fluid was reported as first intervention in 11 (11%) patients. Additional decompressive laparotomy was performed in 8 patients. Decompressive laparotomy was performed in a total of 76 (74%) patients. The median decrease in intraabdominal pressure was 15 mm Hg (range, 33-18 mm Hg). Mortality in acute pancreatitis patients with ACS was 49% versus 11% without ACS. Morbidity ranged from 17% to 90%.Abdominal compartment syndrome during acute pancreatitis is associated with high mortality and morbidity. Studies are relatively small and have methodological shortcomings. The optimal timing and method of invasive interventions, as well as their effect on clinical outcomes, should be further evaluated.
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Azzopardi EA, Azzopardi E, Camilleri L, Villapalos J, Boyce DE, Dziewulski P, Dickson WA, Whitaker IS. Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-. PLoS One 2014; 9:e95042. [PMID: 24751699 PMCID: PMC3994014 DOI: 10.1371/journal.pone.0095042] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 03/22/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres. METHODS Studies investigating adult hospitalised patients (2000-2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance. PRIMARY FINDINGS Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84). INTERPRETATION Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand.
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Affiliation(s)
- Ernest A. Azzopardi
- Institute of Life Science, Swansea University College of Medicine, Singleton Park, Swansea, United Kingodm
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
| | - Elayne Azzopardi
- Research Institute for Health and Social Change, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Elizabeth Gaskell Campus, Manchester, United Kingdom
| | - Liberato Camilleri
- Department of Statistics and Operations, Tal-Qroqq Campus, University of Malta, Msida, Malta
| | - Jorge Villapalos
- Department of Burns and Plastic Surgery, Chelsea and Westminster Hospital NHS Trust, London, United Kingdom
| | - Dean E. Boyce
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
| | - Peter Dziewulski
- St. Andrews Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom
| | - William A. Dickson
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
| | - Iain S. Whitaker
- Institute of Life Science, Swansea University College of Medicine, Singleton Park, Swansea, United Kingodm
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
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Strang SG, Van Lieshout EM, Breederveld RS, Van Waes OJ. A systematic review on intra-abdominal pressure in severely burned patients. Burns 2014; 40:9-16. [DOI: 10.1016/j.burns.2013.07.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/10/2013] [Accepted: 07/02/2013] [Indexed: 12/12/2022]
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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: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Chang M, Yu J, Zhang L, Guo G, Zhang W, Chen J, Chen P, Li Y. A new model for the study of secondary intra-abdominal hypertension in rats. J Surg Res 2013; 187:244-51. [PMID: 24209805 DOI: 10.1016/j.jss.2013.09.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/25/2013] [Accepted: 09/26/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND To build a new and appropriate model of secondary intra-abdominal hypertension (IAH) in rats. METHODS A total of 32 female Sprague-Dawley rats were randomized into four groups. Group I: the rats were hemorrhaged to a mean arterial pressure (MAP) of 40 mm Hg for 1 h and portal hypertension was induced by partial ligation of the portal vein 1 h later; Group II: after inducing portal hypertension, hemorrhagic shock of MAP of 40 mm Hg was induced and maintained for 1 h; Group III: after inducing portal hypertension, hemorrhagic shock of MAP of 40 mm Hg was induced and maintained for 2 h; Group IV: after inducing portal hypertension, hemorrhagic shock of MAP of 40 mm Hg was induced and maintained for 2 h, and a specially designed abdominal restraint device was used. After these procedures, respectively, the collected blood was reinfused and lactated Ringer solution was continuously infused until the secondary IAH model was established. RESULTS No models were built in Groups I, II, and III. One rat died in Group IV after portal vein ligation, and all the remaining rats successfully developed IAH; the success rate was 87.5%. During the resuscitation period, the average time was 5.26 ± 0.59 h and the average total infusion volume was 665.5 ± 86.04 mL/kg. CONCLUSION A rat model of secondary IAH was successfully established by resuscitation after a combination of inducing portal hypertension, hemorrhaging to a MAP of 40 mm Hg for 2 h, and using an abdominal restraint device. All these criteria mimic key etiological factors for the development of secondary IAH.
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Affiliation(s)
- Mingtao Chang
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Jian Yu
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Lianyang Zhang
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China.
| | - Guangkuo Guo
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Weiguo Zhang
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Jinghua Chen
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Peng Chen
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yang Li
- Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
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Ali SR, Mohammad H, Sara S. Evaluation of the relationship between pelvic fracture and abdominal compartment syndrome in traumatic patients. J Emerg Trauma Shock 2013; 6:176-9. [PMID: 23960373 PMCID: PMC3746438 DOI: 10.4103/0974-2700.115330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 11/01/2012] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION An increase in abdominal pressure can lead to so-called intra-abdominal compartment syndrome (ACS). Multiple factors such as an increase in retroperitoneal volume due to pancreatitis, bleeding and edema as a result of pelvic fracture can lead to compartment syndrome. Prevention is better than cure in compartment syndrome. By measuring the intra-abdominal pressure (IAP) through the bladder, a quick and accurate assessment of abdominal pressure is achieved. Therefore, this study aimed to evaluate the relationship between pelvic fracture and ACS in traumatic patients. MATERIALS AND METHODS This research was a descriptive-analytical study conducted on 100 patients referring to the Shiraz Nemazee Hospital in 2010. IAP was monitored every 4 h in patients suspected to be at high risk for ACS, e.g., those undergoing severe abdominal trauma and pelvic fracture. The IAP was measured via the urinary bladder using the procedure described by Kron et al. Data collected were analyzed using SPSS software. RESULTS The findings showed that ACS occurred in 28 of 100 patients. With regard to the associated injuries with abdominal trauma, 19% of all patients and 46/42% of the patients with ACS had pelvic fracture. Chi-square test revealed a significant relationship between pelvic fracture and incidence rate of ACS (P < 0.001). CONCLUSIONS According to the collected data, pelvic fracture due to a trauma can be one of the important causes of an increase in IAP and ACS. In this lethal condition, prevention is better than cure. Therefore, serial measurement of IAP through the bladder in high-risk patients (those with pelvic fracture by trauma) is recommended to the nurses to diagnose this condition and to decrease the incidence of mortality.
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Affiliation(s)
- Sheikhi Rahim Ali
- Department of Nursing, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Struck MF, Reske AW, Schmidt T, Hilbert P, Steen M, Wrigge H. Respiratory functions of burn patients undergoing decompressive laparotomy due to secondary abdominal compartment syndrome. Burns 2013; 40:120-6. [PMID: 23790395 DOI: 10.1016/j.burns.2013.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 04/23/2013] [Accepted: 05/21/2013] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The development of secondary abdominal compartment syndrome (ACS) is associated with multiple organ dysfunction. There is little information about the effects of decompressive laparotomy (DL) on respiratory function (RF) in burn patients developing ACS. PATIENTS AND METHODS We retrospectively obtained data characterising RF from the database of an adult burn intensive care unit (BICU). Peak inspiratory pressure (Pip), PaO2/FiO2-ratio (P/F), static compliance (Cstat) and airway resistance (Raw) were analysed over the course of 60 h at 8 time points relative to DL. RESULTS Thirty-five patients with ACS underwent DL with a mean percentage of total burned body surface area (TBSA) 39 ± 23% and mean intra-abdominal pressure 33 ± 7 mmHg. All patients presented with significantly deteriorating RF within 12h of DL (Pip 33 ± 4 to 39 ± 7 cm/H2O, p=0.003; P/F 232 ± 59 to 160 ± 55 mmHg, p<0.001, Cstat 34 ± 5 to 26 ± 6 mL/cmH2O, p<0.001; Raw 18 ± 3 to 24 ± 9 cm H2O/L/s, p=0.02). All these parameters improved significantly (p<0.001) after DL, regardless of the presence of inhalation injury or torso burns. Mortality was 71.4%. CONCLUSIONS Variables characterising RF demonstrated a rapid deterioration before and a significant and sustained improvement after DL in burn patients developing ACS. Despite these respiratory improvements, DL was associated with low survival rates. Secondary ACS remains a challenge in burn patients and thus warrants particular attention during intensive care treatment.
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Affiliation(s)
- Manuel F Struck
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Leipzig, Germany; Department of Plastic and Hand Surgery, Burn Trauma Centre, Bergmannstrost Hospital, Halle/Saale, Germany.
| | - Andreas W Reske
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Leipzig, Germany
| | - Thomas Schmidt
- Department of Medical Psychology, Bergmannstrost Hospital, Halle/Saale, Germany
| | - Peter Hilbert
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, Bergmannstrost Hospital, Halle/Saale, Germany
| | - Michael Steen
- Department of Plastic and Hand Surgery, Burn Trauma Centre, Bergmannstrost Hospital, Halle/Saale, Germany
| | - Hermann Wrigge
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Leipzig, Germany
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Fujita T. Fluid resuscitation for burn patients at risk for abdominal complications. J Am Coll Surg 2013; 216:1027. [PMID: 23618002 DOI: 10.1016/j.jamcollsurg.2013.01.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 01/23/2013] [Indexed: 10/26/2022]
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Application of topical negative pressure (vacuum-assisted closure) to split-thickness skin grafts: a structured evidence-based review. Ann Plast Surg 2013; 70:23-9. [PMID: 23249474 DOI: 10.1097/sap.0b013e31826eab9e] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Significant controversy surrounds the effectiveness of negative pressure wound therapy although it has been in use for decades. Although many clinicians favor this modality in relation to its practicality, ease of use especially in complex wounds, it has faced the same challenges as other dressings in relation to evidence base of efficacy in relation to a number of outcome measures. In view of the current financial pressures on health care systems worldwide, this structured review systematically challenges the evidence for perioperative application of topical negative pressure (TNP) to split-thickness skin grafts (STSGs) through evidence-based critical appraisal, and extrapolate the mechanisms of action on the mechanisms through which TNP may aid wound healing. Weighted evidence-based recommendations regarding the impact of TNP on split skin graft quality and quantity of take as outcomes. METHODS Phase 1: Structured literature search. Phase 2: Retrieved articles were critically appraised for rigor and methodological validity by 3 independent authors, then stratified according to a validated "levels of evidence" framework. Graded "current best evidence" recommendations could therefore be proposed. RESULTS Of the 220 studies retrieved in the initial search, 38 studies satisfied our quality of evidence criteria. Current best evidence supports 2 complementary trends explaining the mechanisms whereby STSG benefits from TNP. Active stimulation of epithelial mitosis: TNP creates mechanical stretch which stimulates multiple signaling pathways up-regulating growth- and mitosis-associated epithelial transcription factors. Topical negative pressure also promotes microcirculatory flow (graft and wound edge), stimulates angiogenesis and basement membrane integrity (grade C). Prevention of complications: significant reduction of graft lift-off by edema, exudates, subgraft hematoma, and reduction of shear when compared to traditional dressings (grade B). Topical negative pressure promotes significant qualitative improvement in the final STSG result studies (level 1B). The role of TNP in prevention of infection is, however, equivocal and further research is required. No evidence of harm from TNP application was reported. CONCLUSIONS Topical negative pressure increases quantity and quality of split skin graft take compared to traditional bolster dressings. The advantages are increased in irregularly contoured, technically difficult wounds and suboptimal recipient wound beds where it seems to be the best modality currently available. Large-scale randomized clinical controlled trials remain scanty in all areas of wound dressing research including negative pressure therapy.
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Smith SE, Sande AA. Measurement of intra-abdominal pressure in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2013; 22:530-44. [PMID: 23110567 DOI: 10.1111/j.1476-4431.2012.00799.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To review and summarize the human and veterinary literature on intra-abdominal pressure measurement techniques. DATA SOURCES Human and veterinary clinical studies, research articles, reviews, and textbooks with no date restrictions with a focus on techniques for intra-abdominal pressure (IAP) measurement and their limitations. HUMAN DATA SYNTHESIS Human literature has established the intravesicular method as the gold standard for indirect measurement of IAP. However, current research has explored the intragastric method as a valid alternative. Recently, debate has focused on the shortcomings of the various measurement methods. VETERINARY DATA SYNTHESIS Early human literature using dogs as models contributed to the original data for IAP measurements in small animals. Since that time, a number of clinical studies and 1 case report have contributed to that original information. A reference interval for IAP measured by the intravesicular method has recently been determined in healthy cats. CONCLUSIONS Further studies investigating IAP in critically ill veterinary patients are required to establish the optimal technique for this measurement in veterinary medicine.
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Affiliation(s)
- Shelley E Smith
- Department of Emergency and Critical Care, VCA Veterinary Referral Associates, Gaithersburg, MD 20877, USA.
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Vaughn L, Beckel N, Walters P. Severe burn injury, burn shock, and smoke inhalation injury in small animals. Part 2: diagnosis, therapy, complications, and prognosis. J Vet Emerg Crit Care (San Antonio) 2013; 22:187-200. [PMID: 23016810 DOI: 10.1111/j.1476-4431.2012.00728.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To review the evaluation and treatment of patients suffering from severe burn injury (SBI), burn shock, and smoke inhalation injury. Potential complications and prognosis associated with SBI are also discussed. DIAGNOSIS Diagnosis of burn injury and burn shock is based on patient history and clinical presentation. Superficial burn wounds may not be readily apparent for the first 48 h whereas more severe wounds will be evident at presentation. Patients are diagnosed with local or SBI by estimating total body surface area involved using the 'Rule of Nines' or the Lund-Browder chart adapted from the human literature. THERAPY Patients suffering from SBI require immediate and aggressive fluid therapy. Burn wounds require prompt cooling to prevent progressive tissue damage. Due to significant pain associated with burn wounds and therapeutic procedures, multimodal analgesia is recommended. Daily wound management including hydrotherapy, topical medications, and early wound excision and grafting is necessary with SBI. COMPLICATIONS There are numerous complications associated with SBI. The most common complications include infections, hypothermia, intra-abdominal hypertension, and abdominal compartment syndrome. PROGNOSIS The prognosis of SBI in domestic animals is unknown. Based on information derived from human literature, patients with SBI and concomitant smoke inhalation likely have a worse prognosis than those with SBI or smoke inhalation alone.
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Affiliation(s)
- Lindsay Vaughn
- New England Animal Medical Center, West Bridgewater, MA 02379, USA.
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Michaeli B, Carron PN, Revelly JP, Bernath MA, Schrag C, Berger M. Überinfusion von Verbrennungsopfern: häufig und schädlich. Notf Rett Med 2013. [DOI: 10.1007/s10049-012-1588-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Struck MF, Illert T, Schmidt T, Reichelt B, Steen M. Secondary abdominal compartment syndrome in patients with toxic epidermal necrolysis. Burns 2012; 38:562-7. [DOI: 10.1016/j.burns.2011.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 10/06/2011] [Accepted: 10/12/2011] [Indexed: 10/15/2022]
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Computerized decision support system improves fluid resuscitation following severe burns: an original study. Crit Care Med 2011; 39:2031-8. [PMID: 21532472 DOI: 10.1097/ccm.0b013e31821cb790] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Several formulas have been developed to guide resuscitation in severely burned patients during the initial 48 hrs after injury. These approaches require manual titration of fluid that may result in human error during this process and lead to suboptimal outcomes. The goal of this study was to analyze the efficacy of a computerized open-loop decision support system for burn resuscitation compared to historical controls. DESIGN Fluid infusion rates and urinary output from 39 severely burned patients with >20% total body surface area burns were recorded upon admission (Model group). A fluid-response model based on these data was developed and incorporated into a computerized open-loop algorithm and computer decision support system. The computer decision support system was used to resuscitate 32 subsequent patients with severe burns (computer decision support system group) and compared with the Model group. SETTING Burn intensive care unit of a metropolitan Level 1 Trauma center. PATIENTS Acute burn patients with >20% total body surface area requiring active fluid resuscitation during the initial 24 to 48 hours after burn. MEASUREMENTS AND MAIN RESULTS We found no significant difference between the Model and computer decision support system groups in age, total body surface area, or injury mechanism. Total crystalloid volume during the first 48 hrs post burn, total crystalloid intensive care unit volume, and initial 24-hr crystalloid intensive care unit volume were all lower in the computer decision support system group. Infused volume per kilogram body weight (mL/kg) and per percentage burn (mL/kg/total body surface area) were also lower for the computer decision support system group. The number of patients who met hourly urinary output goals was higher in the computer decision support system group. CONCLUSIONS Implementation of a computer decision support system for burn resuscitation in the intensive care unit resulted in improved fluid management of severely burned patients. All measures of crystalloid fluid volume were reduced while patients were maintained within urinary output targets a higher percentage of the time. The addition of computer decision support system technology improved patient care.
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James MFM, Michell WL, Joubert IA, Nicol AJ, Navsaria PH, Gillespie RS. Resuscitation with hydroxyethyl starch improves renal function and lactate clearance in penetrating trauma in a randomized controlled study: the FIRST trial (Fluids in Resuscitation of Severe Trauma). Br J Anaesth 2011; 107:693-702. [PMID: 21857015 DOI: 10.1093/bja/aer229] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The role of fluids in trauma resuscitation is controversial. We compared resuscitation with 0.9% saline vs hydroxyethyl starch, HES 130/0.4, in severe trauma with respect to resuscitation, fluid volume, gastrointestinal recovery, renal function, and blood product requirements. METHODS Randomized, controlled, double-blind study of severely injured patients requiring >3 litres of fluid resuscitation. Blunt and penetrating trauma were randomized separately. Patients were followed up for 30 days. RESULTS A total of 115 patients were randomized; of which, 109 were studied. For patients with penetrating trauma (n=67), the mean (sd) fluid requirements were 5.1 (2.7) litres in the HES group and 7.4 (4.3) litres in the saline group (P<0.001). In blunt trauma (n=42), there was no difference in study fluid requirements, but the HES group required significantly more blood products [packed red blood cell volumes 2943 (1628) vs 1473 (1071) ml, P=0.005] and was more severely injured than the saline group (median injury severity score 29.5 vs 18; P=0.01). Haemodynamic data were similar, but, in the penetrating group, plasma lactate concentrations were lower over the first 4 h (P=0.029) and on day 1 with HES than with saline [2.1 (1.4) vs 3.2 (2.2) mmol litre⁻¹; P=0.017]. There was no difference between any groups in time to recovery of bowel function or mortality. In penetrating trauma, renal injury occurred more frequently in the saline group than the HES group (16% vs 0%; P=0.018). In penetrating trauma, maximum sequential organ function scores were lower with HES than with saline (median 2.4 vs 4.5, P=0.012). No differences were seen in safety measures in the blunt trauma patients. CONCLUSIONS In penetrating trauma, HES provided significantly better lactate clearance and less renal injury than saline. No firm conclusions could be drawn for blunt trauma. STUDY REGISTRATION ISRCTN 42061860.
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Affiliation(s)
- M F M James
- Department of Anaesthesia, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, Western Cape 7925, South Africa.
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Increase in early mechanical ventilation of burn patients: an effect of current emergency trauma management? ACTA ACUST UNITED AC 2011; 70:611-5. [PMID: 21610350 DOI: 10.1097/ta.0b013e31821067aa] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data relating to patients admitted with extensive burn injuries in the Netherlands have revealed a marked increase in patients whose initial care included mechanical ventilation (MV). The increase was abrupt, dating from 1997, and has been sustained since. The aim of this study is to quantify this observation and to discuss possible causes. METHODS The study included 258 consecutive patients with burns >30% total body surface area admitted to the Beverwijk burns center. Patients were divided into two groups based on admission date: group 1 from 1987 to 1996 (n=135) and group 2 from 1997 to 2006 (n=123). Data were analyzed using χ or analysis of variance. RESULTS There were no differences between groups in demographics, facial burns, inhalation injury, and % total body surface area. However, the number of patients subjected to MV at admission increased from 38% to 76% (group 1 vs. 2; p<0.001). In 57% of patients who were intubated based on the suspicion of inhalation injury, this condition could not be confirmed (p<0.05 vs. 9% [1987-1996]). CONCLUSIONS This study has confirmed that a higher proportion of patients were treated with MV since 1997, whereas the severity of burn injury remained unchanged throughout the study period. In the absence of a clinical explanation, we surmise that there has been a change within Dutch casualty departments in the initial management of major burn injury. The change coincides with the implementation of the Advanced Life Trauma Support training course as the accepted standard of trauma care in Dutch hospitals.
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Guttormsen AB, Onarheim H, Thorsen J, Jensen SA, Rosenberg BE. [Treatment of serious burns]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:1236-41. [PMID: 20567275 DOI: 10.4045/tidsskr.08.0391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Treatment of patients with large burns is challenging. MATERIAL AND METHOD The article is based on clinical experience, and a non-systematic review in PubMed. RESULTS In patients with burns covering more than 10 - 15 % of the total body surface area, fluid resuscitation should be initiated early. Fluid induces edema, and facial burns may necessitate early orotracheal intubation to secure the airways. Reduced ventilation and-/or peripheral circulation due to deep burns should be managed by early escharotomy (and, more seldom, fasciotomy) at the primary hospital. Respiratory distress is most often due to vigorous fluid resuscitation, secretions, pneumonia and-/or sepsis. Fiber bronchoscopy may reveal inhalation injury and enables removal of secreted material from the airways. In the acute initial phase, hypotension is usually caused by hypovolemia. Subsequently a massive inflammatory response (SIRS) causes vasodilatation, hypotension and increased cardiac output. Wound and airway infections are common. SIRS may cause CRP levels above 100 and a body temperature of 38 - 39 degrees C, which makes it difficult to find the right time to start antibiotic treatment. Nevertheless, prophylactic use of antibiotics is not encouraged. Definitive surgery, excision and transplantation, should be performed early, preferably within the first week. INTERPRETATION Patients with large burns should be treated according to general principles for intensive medical care, preferably in units with special experience in treatment of burns.
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Affiliation(s)
- Anne Berit Guttormsen
- Kirurgisk serviceklinikk, Haukeland universitetssykehus, 5021 Bergen og Institutt for kirurgiske fag Universitetet i Bergen, Norway.
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