1
|
Xiao K, Chen WX, Li XJ. Analysis of risk factors of prolonged mechanical ventilation in patients with severe burn injury. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:791-798. [PMID: 37519126 PMCID: PMC10435940 DOI: 10.1111/crj.13673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/30/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Mechanical ventilation is an essential means of life support for patients with severe burns. However, prolonged mechanical ventilation (PMV) increases the incidence of complications and length of hospital stay. Therefore, studying the risk factors of mechanical ventilation duration is of great significance for reducing the duration of mechanical ventilation, reducing related complications, and improving the success rate of severe burn treatment. METHOD This study was a retrospective study of patients with burns ≥30% of the area admitted to the BICU of Guangzhou Red Cross Hospital affiliated with Jinan University from January 2016 to January 2023 who were mechanically ventilated. Patients were classified into the prolonged mechanical ventilation group if they were mechanically ventilated for ≥21 days. Then, independent risk factors for prolonged mechanical ventilation were determined by logistic regression analysis of the collected data. RESULT Of all the 112 enrolled patients, 79 had prolonged mechanical ventilation, with an incidence of 70.5%. Logistic regression analysis revealed that including abbreviated burn severity index (ABSI%) (P < 0.001), moderate and severe inhalation injury (P = 0.005, P = 0.044), albumin (P = 0.032), lactic acid (P < 0.001) were independent risk factors for prolonged mechanical ventilation. In addition, ventilator-related complications were 44% in the PMV group and 21% in the non-PMV group. CONCLUSION ABSI%, inhalation injury, albumin, and lactic acid on admission are the risk factors for PMV in severe burn patients. In addition, ventilator-related complications were higher in group PMV than in group non-PMV in our study.
Collapse
Affiliation(s)
- Kui Xiao
- Department of Burn and Plastic Surgery, Guangzhou Red Cross HospitalJinan UniversityGuangzhouChina
| | | | - Xiao Jian Li
- Department of Burn and Plastic Surgery, Guangzhou Red Cross HospitalJinan UniversityGuangzhouChina
| |
Collapse
|
2
|
Ji Q, Tang J, Li S, Chen J. Survival and analysis of prognostic factors for severe burn patients with inhalation injury: based on the respiratory SOFA score. BMC Emerg Med 2023; 23:1. [PMID: 36604623 PMCID: PMC9813898 DOI: 10.1186/s12873-022-00767-6] [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] [Received: 08/02/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND It is important to determine the severity of inhalation injury in severely burned patients. The oxygenation index PaO2/FiO2(PF) ratio is a key clinical indicator of inhalation injury. Sequential organ failure assessment (SOFA) is developed to assess the acute incidence of critical illness in the population. We hope to provide an assessment of survival or prognostic factor for severely burned patients with inhalation injury based on the respiratory SOFA score. METHODS This is a retrospective cohort study of all admissions to Department of Burn and Plastic Surgery at West China Hospital of Sichuan University from July 2010 to March 2021. Data was analyzed using Cox regression models to determine significant predictors of mortality. Survival analysis with time to death event was performed using the Kaplan-Meier survival curve with the log-rank test. All potential risk factors were considered independent variables, while survival was considered the risk dependent variable. RESULTS One hundred eighteen severe burn patients with inhalation injury who met the inclusion and exclusion criteria were admitted, including men accounted for 76.3%. The mean age and length of stay were 45.9 (14.8) years and 44.3 (38.4) days. Flame burns are the main etiology of burn (74.6%). Patients with the respiratory SOFA score greater than 2 have undergone mechanical ventilation. Univariate Kaplan-Meier analysis identified age, total body surface area burned (TBSA), ICU admission and the respiratory SOFA score as significant factors on survival. Cox regression analysis showed that TBSA and the respiratory SOFA score were associated with patient survival (p < 0.001). In some patients with severe burns and inhalation damage, the survival probability drops to less than 10% (TBSA greater than 80%: 8.9% and respiratory SOFA score greater than 2: 5.6%). This study statistically found that the TBSA with the respiratory SOFA score model (AUROC: 0.955) and the rBaux score (AUROC: 0.927) had similar predictive value (p = 0.175). CONCLUSION The study indicates that a high respiratory system SOFA score was identified as a strong and independent predictor of severely burned patients with inhalation injury during hospitalization. When combined with TBSA, the respiratory SOFA scores can dynamically assess the severity of the patient's lung injury and improve the predictive level.
Collapse
Affiliation(s)
- Qiang Ji
- grid.412901.f0000 0004 1770 1022Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Guoxue Alley, Wuhou District, 610041 Chengdu, China
| | - Jun Tang
- grid.412901.f0000 0004 1770 1022Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Guoxue Alley, Wuhou District, 610041 Chengdu, China
| | - Shulian Li
- grid.412901.f0000 0004 1770 1022Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Guoxue Alley, Wuhou District, 610041 Chengdu, China ,grid.412901.f0000 0004 1770 1022 Department of Thyroid Surgery, West China Hospital, Sichuan University, Guoxue Alley, Wuhou District, 610041 Chengdu, China
| | - Junjie Chen
- grid.412901.f0000 0004 1770 1022Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Guoxue Alley, Wuhou District, 610041 Chengdu, China
| |
Collapse
|
3
|
Factors Associated With Mechanical Ventilation Duration in Pediatric Burn Patients in a Regional Burn Center in the United States. Pediatr Crit Care Med 2022; 23:e536-e540. [PMID: 36040074 DOI: 10.1097/pcc.0000000000003068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Among burned children who arrive at a burn center and require invasive mechanical ventilation (IMV), some may have prolonged IMV needs. This has implications for patient-centered outcomes as well as triage and resource allocation decisions. Our objective was to identify factors associated with the duration of mechanical ventilation in pediatric patients with acute burn injury in this setting. DESIGN Single-center, retrospective cohort study. SETTING Registry data from a regional, pediatric burn center in the United States. PATIENTS Children less than or equal to 18 years old admitted with acute burn injury who received IMV between January 2005 and December 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Ventilator days were defined as any full or partial day having received IMV via an endotracheal tube or tracheostomy, not inclusive of time spent ventilated for procedures. Of 5,766 admissions for acute burn care, 4.3% ( n = 249) required IMV with a median duration of 10 days. A multivariable model for freedom from mechanical ventilation showed that the presence of inhalational injury (subhazard ratio [sHR], 0.62; 95% CI, 0.46-0.85) and burns to the head and neck region (sHR, 0.94; 95% CI, 0.90-0.98) were associated with increased risk of remaining mechanically ventilated at any time point. Older (sHR, 1.03; 95% CI, 1.01-1.04) and male children (sHR, 1.39; 95% CI, 1.05-1.84) were more likely to discontinue mechanical ventilation. A majority of children (94.8%) survived to hospital discharge. CONCLUSIONS The presence of inhalational injury and burns to the head and neck region were associated with a longer duration of mechanical ventilation. Older age and male gender were associated with a shorter duration of mechanical ventilation. These factors should help clinicians better estimate a burned child's expected trajectory and resource-intensive needs upon arrival to a burn center.
Collapse
|
4
|
Schappacher R, Rapp M, Muth CM, Nölke J, Amrehn L, Liener U, Bökeler U, Orth M, Fillies T. Periodontal damage after thermal inhalation injury - The impact of high temperature inhalation injury on long term periodontal health. Burns 2022; 48:952-958. [PMID: 34933749 DOI: 10.1016/j.burns.2021.08.008] [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: 11/12/2020] [Revised: 08/02/2021] [Accepted: 08/10/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Thermal inhalation injury is a common, life-threatening problem in burned patients. Whether or not this single event of damage to the oral integrity causes long term health problems is yet to be examined. MATERIAL AND METHODS All consecutive burn patients between 2014 and 2017 of Marienhospital Stuttgart (MHS), Germany, with at least 10% of burned skin surface were included and compared. The Periodontal Screening Index as well as Vitamin D levels were examined. Vitamin D has been suspected to contribute to the genesis of periodontitis. Risk factors and subjective oral life quality were prompted. RESULTS We included a total of 32 patients, 15 of which had an inhalation injury in their medical history. Risk factors were examined via Renatus' questionnaire. While risk factors were equally distributed in both groups we saw a remarkable difference in periodontal integrity, with the Periodontal Screening Index (PSI) per sextant differing drastically (with inhalation injury: 2.40, without inhalation injury: 1.10, p < 0.001). Patients with an inhalation injury had a mean of 5.2 out of 6 possible sextants with a pathologic PSI (with the median being 6/6), while patients without an inhalation injury had a mean of 1.83 out of 6 (median: 1/6), p < 0.001. The oral health impact profile showed a difference as well, albeit without statistical significance (with inhalation injury: median = 11, without: median = 3.5, p = 0.414). A correlation between Serum Vitamin D levels and periodontal integrity could not be seen in this group. CONCLUSION Inhalation injury is a possible cause for periodontitis and hence impacts the quality of life of burned patients.
Collapse
Affiliation(s)
- Robert Schappacher
- Department of Craniomaxillofacial Surgery, Marienhospital Stuttgart, Boeheimstrasse 37, 70199 Stuttgart, Germany; Department of Orthopaedic and Trauma Surgery, Stuttgart Burn Center, Marienhospital Stuttgart, Boeheimstrasse 37, 70199 Stuttgart, Germany; Clinic for Aneasthesiology, Department of Emergency Medicine, University Hospital Ulm Medical Center, Prittwitzstrasse 43, 89075 Ulm, Germany.
| | - Matthias Rapp
- Department of Orthopaedic and Trauma Surgery, Stuttgart Burn Center, Marienhospital Stuttgart, Boeheimstrasse 37, 70199 Stuttgart, Germany
| | - Claus-Martin Muth
- Clinic for Aneasthesiology, Department of Emergency Medicine, University Hospital Ulm Medical Center, Prittwitzstrasse 43, 89075 Ulm, Germany
| | - Jan Nölke
- Department of Craniomaxillofacial Surgery, Marienhospital Stuttgart, Boeheimstrasse 37, 70199 Stuttgart, Germany
| | - Lance Amrehn
- Department of Craniomaxillofacial Surgery, Marienhospital Stuttgart, Boeheimstrasse 37, 70199 Stuttgart, Germany
| | - Ulrich Liener
- Department of Orthopaedic and Trauma Surgery, Stuttgart Burn Center, Marienhospital Stuttgart, Boeheimstrasse 37, 70199 Stuttgart, Germany
| | - Ulf Bökeler
- Department of Orthopaedic and Trauma Surgery, Stuttgart Burn Center, Marienhospital Stuttgart, Boeheimstrasse 37, 70199 Stuttgart, Germany
| | - Matthias Orth
- Department of Laboratory Medicine, Marienhospital Stuttgart, Boeheimstrasse 37, 70199 Stuttgart, Germany
| | - Thomas Fillies
- Department of Craniomaxillofacial Surgery, Marienhospital Stuttgart, Boeheimstrasse 37, 70199 Stuttgart, Germany
| |
Collapse
|
5
|
McCrory MC, Woodruff AG, Saha AK, Halvorson EE, Critcher BM, Holmes JH. Characteristics of Burn-Injured Children in 117 U.S. PICUs (2009-2017): A Retrospective Virtual Pediatric Systems Database Study. Pediatr Crit Care Med 2021; 22:616-628. [PMID: 33689253 DOI: 10.1097/pcc.0000000000002660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe characteristics and outcomes of children with burn injury treated in U.S. PICUs. DESIGN Retrospective study of admissions in the Virtual Pediatric Systems, LLC, database from 2009 to 2017. SETTING One hundred and seventeen PICUs in the United States. PATIENTS Patients less than 18 years old admitted with an active diagnosis of burn at admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 2,056 patients were included. They were predominantly male (62.6%) and less than 6 years old (66.7%). Cutaneous burns were recorded in 92.1% of patients, mouth/pharynx burns in 5.8%, inhalation injury in 5.1%, and larynx/trachea/lung burns in 4.5%. Among those with an etiology recorded (n = 861), scald was most common (38.6%), particularly in children less than 2 years old (67.8%). Fire/flame burns were most common (46.6%) in children greater than or equal to 2 years. Multiple organ failure was present in 26.2% of patients. Most patients (89%) were at facilities without American Burn Association pediatric verification. PICU mortality occurred in 4.5% of patients. On multivariable analysis using Pediatric Index of Mortality 2, greater than or equal to 30% total body surface area burned was significantly associated with mortality (odds ratio, 5.40; 95% CI, 2.16-13.51; p = 0.0003). When Pediatric Risk of Mortality III was used, greater than or equal to 30% total body surface area burned (odds ratio, 5.45; 95% CI, 1.95-15.26; p = 0.001) and inhalation injury (odds ratio, 5.39; 95% CI, 1.58-18.42; p = 0.007) were significantly associated with mortality. Among 366 survivors (18.6%) with Pediatric Cerebral Performance Category or Pediatric Overall Performance Category data, 190 (51.9%) had a greater than or equal to 1 point increase in Pediatric Cerebral Performance Category or Pediatric Overall Performance Category disability category and 80 (21.9%) had a new designation of moderate or severe disability, or persistent vegetative state. CONCLUSIONS Burn-injured patients in U.S. PICUs have a substantial burden of organ failure, morbidity, and mortality. Coordination among specialized facilities may be particularly important in this population, especially for those with higher % total body surface area burned or inhalation injury.
Collapse
Affiliation(s)
- Michael C McCrory
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Alan G Woodruff
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
- Center for Redox in Biology and Medicine, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Nursing, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Amit K Saha
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | | | | | - James H Holmes
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| |
Collapse
|
6
|
Chen L, He X, Xian J, Liao J, Chen X, Luo Y, Wang Z, Li N. Development of a framework for managing severe burns through a 17-year retrospective analysis of burn epidemiology and outcomes. Sci Rep 2021; 11:9374. [PMID: 33931691 PMCID: PMC8087787 DOI: 10.1038/s41598-021-88507-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/07/2021] [Indexed: 11/09/2022] Open
Abstract
Burns are one of the most common injuries in daily life for all ages of population. This study was to investigate the epidemiology and outcomes among burn patients in one of the largest burn centers in the southwest of China. The study was performed at the Institute of Burn Research in the first affiliated with the Army Medical University (AMU). A total of 17,939 burn patients were included in this retrospective study. Information regarding burn epidemiology and outcomes in 17 years were collected, calculated and compared. The age ranged from 257 days to 95 years old. Scalding and flame were the two most common causes to burn injuries, comprising of 91.96% in total. Limbs, head/face/neck, and trunk were the most frequently occurred burn sites, with the number and the percent of 12,324 (68.70%), 7989 (44.53%), and 7771 (43.32%), respectively. The average total body surface area (TBSA) was 13.64 ± 16.83% (median 8%) with a range of 0.1–100%. A total of 874 (4.9%) patients had TBSA > 50%. The presence of a burn with an inhalation injury was confirmed in 543 patients (3.03%). The average LOS was 32.11 ± 65.72 days (median: 17 days). Eventually, the retrospective analysis resulted in the development of a burn management continuum used for developing strategies to prevent and manage severe burns. The annual number of burn injuries has kept decreasing, which was partially attributed to the increased awareness and education of burn prevention and the improved burn-preventative circumstances. However, the burn severity and the economic burden were still in a high level. And the gender difference and age difference should be considered when making individualized interventions and rehabilitative treatments.
Collapse
Affiliation(s)
- Ling Chen
- Department of Emergency, The 958th Hospital of PLA, The Affiliated Hospital of Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400020, People's Republic of China
| | - Xiaochong He
- School of Nursing, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China
| | - Jishu Xian
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China
| | - Jianmei Liao
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China
| | - Xuanji Chen
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Yue Luo
- Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street No.30, Shapingba District, Chongqing, 400038, People's Republic of China
| | - Zonghua Wang
- School of Nursing, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China.
| | - Ning Li
- Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street No.30, Shapingba District, Chongqing, 400038, People's Republic of China.
| |
Collapse
|
7
|
Coulter MJ, Mickelson RC, Dye JL, Shannon KB, Ambrosio AA. Serious Inhalation Injuries From Military Operations in Afghanistan, Iraq, and Syria. J Intensive Care Med 2020; 36:1061-1065. [PMID: 32914702 DOI: 10.1177/0885066620956618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To characterize serious inhalation injuries seen during recent military operations, and assess whether bronchoscopic severity findings were associated with clinical presentation and outcomes. METHODS Service members who suffered inhalation injuries while deployed to Iraq, Afghanistan, or Syria from 2001-2018 were identified using ICD-9 and 10 codes from the Expeditionary Medical Encounter Database (EMED), which is abstracted from patient records in forward-deployed medical facilities. Further information including demographics, mechanism of injury, mortality, total burn surface area (TBSA), degree of facial burn, total Injury Severity Score (ISS), and first post-injury bronchoscopy notes were collected. Patients were excluded with ISS less than 16 or without sufficient details regarding bronchoscopy. Injuries were grouped based on bronchoscopic Abbreviated Injury Scores (AIS) into low-grade (AIS of 1), moderate-grade (AIS of 2), or high-grade (AIS of 3 or 4). RESULTS 91 patients met inclusion criteria, with no significant differences in age, gender, paygrade, or service branch between degrees of injury. There were no statistical correlations between grade of injury and battle versus non-battle injury, blast versus non-blast mechanism, TBSA, or degree of facial burn. High-grade injuries had significantly higher ISS than low or moderate-grade injuries. After adjusting for ISS, the odds ratio of death was 10.4 (95% CI 1.47 to 74.53) for those with high-grade and 3.7 (95% CI 0.45 to 32.30) for those with moderate-grade compared to low-grade injuries. CONCLUSION In this cohort of deployed military members with inhalation injuries, initial bronchoscopic severity findings are strongly associated with mortality even after adjusting for ISS. The AIS may be an important prognostic tool in all of those with serious inhalation injuries.
Collapse
Affiliation(s)
- Michael J Coulter
- Department of Otolaryngology/Head and Neck Surgery, 19938Naval Medical Center, San Diego, CA, USA
| | - Roxanne C Mickelson
- Department of Otolaryngology/Head and Neck Surgery, 19938Naval Medical Center, San Diego, CA, USA
| | - Judy L Dye
- Leidos, San Diego, CA, USA.,Naval Health Research Center, San Diego, CA, USA
| | - Kaeley B Shannon
- Naval Health Research Center, San Diego, CA, USA.,Axiom Resource Management, Inc, Falls Church, VA, USA
| | - Art A Ambrosio
- Department of Otolaryngology/Head and Neck Surgery, 19938Naval Medical Center, San Diego, CA, USA.,Virtual Medical Center Indo-Pacific, 19938Naval Medical Center San Diego, CA, USA
| |
Collapse
|
8
|
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.
Collapse
|
9
|
Legrand M, Barraud D, Constant I, Devauchelle P, Donat N, Fontaine M, Goffinet L, Hoffmann C, Jeanne M, Jonqueres J, Leclerc T, Lefort H, Louvet N, Losser MR, Lucas C, Pantet O, Roquilly A, Rousseau AF, Soussi S, Wiramus S, Gayat E, Blet A. Management of severe thermal burns in the acute phase in adults and children. Anaesth Crit Care Pain Med 2020; 39:253-267. [PMID: 32147581 DOI: 10.1016/j.accpm.2020.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To provide recommendations to facilitate the management of severe thermal burns during the acute phase in adults and children. DESIGN A committee of 20 experts was asked to produce recommendations in six fields of burn management, namely, (1) assessment, admission to specialised burns centres, and telemedicine; (2) haemodynamic management; (3) airway management and smoke inhalation; (4) anaesthesia and analgesia; (5) burn wound treatments; and (6) other treatments. At the start of the recommendation-formulation process, a formal conflict-of-interest policy was developed and enforced throughout the process. The entire process was conducted independently of any industry funding. The experts drew up a list of questions that were formulated according to the PICO model (Population, Intervention, Comparison, and Outcomes). Two bibliography experts per field analysed the literature published from January 2000 onwards using predefined keywords according to PRISMA recommendations. The quality of data from the selected literature was assessed using GRADE® methodology. Due to the current paucity of sufficiently powered studies regarding hard outcomes (i.e. mortality), the recommendations are based on expert opinion. RESULTS The SFAR guidelines panel generated 24 statements regarding the management of acute burn injuries in adults and children. After two scoring rounds and one amendment, strong agreement was reached for all recommendations. CONCLUSION Substantial agreement was reached among a large cohort of experts regarding numerous strong recommendations to optimise the management of acute burn injuries in adults and children.
Collapse
Affiliation(s)
- Matthieu Legrand
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, United States.
| | - Damien Barraud
- Hôpital de Mercy, Intensive Care Medicine and Burn Centre, CHR Metz-Thionville, Ars-Laquenexy, France
| | - Isabelle Constant
- Anaesthesiology Department, Hôpital Armand-Trousseau, Sorbonne Université, Assistance publique-Hôpitaux de Paris, Paris, France
| | | | - Nicolas Donat
- Burn Centre, Percy Military Teaching Hospital, Clamart, France
| | - Mathieu Fontaine
- Burn Intensive Care Unit, Saint-Joseph Saint-Luc Hospital, 20, quai Claude-Bernard, 69007 Lyon, France
| | - Laetitia Goffinet
- Paediatric Burn Centre, University Hospital of Nancy, 54511 Vandœuvre-Lès-Nancy, France
| | | | - Mathieu Jeanne
- CHU Lille, Anaesthesia and Critical Care, Burn Centre, 59000 Lille, France; University of Lille, Inserm, CHU Lille, CIC 1403, 59000 Lille, France; University of Lille, EA 7365 - GRITA, 59000 Lille, France
| | - Jeanne Jonqueres
- Burn Intensive Care Unit, Saint-Joseph Saint-Luc Hospital, 20, quai Claude-Bernard, 69007 Lyon, France
| | - Thomas Leclerc
- Burn Centre, Percy Military Teaching Hospital, Clamart, France
| | - Hugues Lefort
- Department of emergency medicine, Legouest Military Teaching Hospital, Metz, France
| | - Nicolas Louvet
- Anaesthesiology Department, Hôpital Armand-Trousseau, Sorbonne Université, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Marie-Reine Losser
- Hôpital de Mercy, Intensive Care Medicine and Burn Centre, CHR Metz-Thionville, Ars-Laquenexy, France; Paediatric Burn Centre, University Hospital of Nancy, 54511 Vandœuvre-Lès-Nancy, France; Inserm UMR 1116, Team 2, 54000 Nancy, France; University of Lorraine, 54000 Nancy, France
| | - Célia Lucas
- Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France
| | - Olivier Pantet
- Service of Adult Intensive Care Medicine and Burns, Lausanne University Hospital (CHUV), BH 08-651, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Antoine Roquilly
- Department of Anaesthesia and Critical Care, Hôtel-Dieu, University Hospital of Nantes, Nantes, France; Laboratoire UPRES EA 3826 "Thérapeutiques cliniques et expérimentales des infections", University of Nantes, Nantes, France
| | | | - Sabri Soussi
- Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Interdepartmental Division of Critical Care, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sandrine Wiramus
- Department of Anaesthesia and Intensive Care Medicine and Burn Centre, University Hospital of Marseille, La Timone Hospital, Marseille, France
| | - Etienne Gayat
- Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France
| | - Alice Blet
- Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France; Department of Research, University of Ottawa Heart Institute, Ottawa, ON, Canada
| |
Collapse
|
10
|
Stutchfield C, Davies A, Young A. Fluid resuscitation in paediatric burns: how do we get it right? A systematic review of the evidence. Arch Dis Child 2019; 104:280-285. [PMID: 30262511 DOI: 10.1136/archdischild-2017-314504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 08/06/2018] [Accepted: 08/24/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Optimal fluid resuscitation in children with major burns is crucial to prevent or minimise burn shock and prevent complications of over-resuscitation. OBJECTIVES To identify studies using endpoints to guide fluid resuscitation in children with burns, review the range of reported endpoint targets and assess whether there is evidence that targeted endpoints impact on outcome. DESIGN Systematic review. METHODS Medline, Embase, Cinahl and the Cochrane Central Register of Controlled Trials databases were searched with no restrictions on study design or date. Search terms combined burns, fluid resuscitation, endpoints, goal-directed therapy and related synonyms. Studies reporting primary data regarding children with burns (<16 years) and targeting fluid resuscitation endpoints were included. Data were extracted using a proforma and the results were narratively reviewed. RESULTS Following screening of 777 unique references, 7 studies fulfilled the inclusion criteria. Four studies were exclusively paediatric. Six studies used urine output (UO) as the primary endpoint. Of these, one set a minimum UO threshold, while the remainder targeted a range from 0.5-1.0 mL/kg/hour to 2-3 mL/kg/hour. No studies compared different UO targets. Heterogeneous study protocols and outcomes precluded comparison between the UO targets. One study targeted invasive haemodynamic variables, but this did not significantly affect patient outcome. CONCLUSIONS Few studies have researched resuscitation endpoints for children with burns. Those that have done so have investigated heterogeneous endpoints and endpoint targets. There is a need for future randomised controlled trials to identify optimal endpoints with which to target fluid resuscitation in children with burns.
Collapse
Affiliation(s)
| | - Anna Davies
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Amber Young
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| |
Collapse
|
11
|
Abstract
Pediatric burns are a leading cause of injury and mortality in children in the United States. Prompt resuscitation and management is vital to survival in severe pediatric burns. Although management principles are similar to their adult counterparts, children have unique pathophysiologic responses to burn injury thus an understanding of the differences in fluid resuscitation requirements, airway management, burn and wound care is essential to optimize their outcomes.
Collapse
Affiliation(s)
- Mary K Arbuthnot
- Naval Medical Center Camp Lejeune, Department of General Surgery, 100 Brewster Blvd., Camp Lejeune, NC 28547, USA.
| | - Alejandro V Garcia
- Johns Hopkins Hospital, Department of Pediatric Surgery, 1800 Orleans St. Bloomberg Bldg 7313, Baltimore, MD 21287, USA.
| |
Collapse
|
12
|
Barcellos LG, Silva APPD, Piva JP, Rech L, Brondani TG. Characteristics and outcome of burned children admitted to a pediatric intensive care unit. Rev Bras Ter Intensiva 2018; 30:333-337. [PMID: 30304085 PMCID: PMC6180472 DOI: 10.5935/0103-507x.20180045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/10/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To analyze the characteristics and outcomes of children hospitalized for
burns in a pediatric trauma intensive care unit for burn patients. Methods An observational study was conducted through the retrospective analysis of
children (< 16 years) admitted to the pediatric trauma intensive care
unit for burn victims between January 2013 and December 2015.
Sociodemographic and clinical variables were analyzed including the causal
agent, burned body surface, presence of inhalation injury, length of
hospital stay and mortality. Results The study analyzed a sum of 140 patients; 61.8% were male, with a median age
of 24 months and an overall mortality of 5%. The main cause of burns was
scalding (51.4%), followed by accidents involving fire (38.6%) and electric
shock (6.4%). Mechanical ventilation was used in 20.7% of the cases.
Associated inhalation injury presented a relative risk of 6.1 (3.5 - 10.7)
of needing ventilatory support and a relative risk of mortality of 14.1 (2.9
- 68.3) compared to patients without this associated injury. A significant
connection was found between burned body surface and mortality (p <
0.002), reaching 80% in patients with a burned area greater than 50%.
Patients who died had a significantly higher Tobiasen Abbreviated Burn
Severity Index than survivors (9.6 ± 2.2 versus 4.4
± 1.1; p < 0.001). A Tobiasen Abbreviated Burn Severity Index
≥ 7 represented a relative risk of death of 68.4 (95%CI 9.1 -
513.5). Conclusion Scalding burns are quite frequent and are associated with high morbidity.
Mortality is associated with the amount of burned body surface and the
presence of inhalation injury. Special emphasis should be given to accidents
involving fire, reinforcing proper diagnosis and treatment of inhalation
injury.
Collapse
Affiliation(s)
- Luciana Gil Barcellos
- Unidade de Terapia Intensiva de Trauma Pediátrico, Hospital Municipal de Pronto Socorro de Porto Alegre - Porto Alegre (RS), Brasil.,Unidade de Tratamento Intensivo Pediátrico, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Ana Paula Pereira da Silva
- Unidade de Terapia Intensiva de Trauma Pediátrico, Hospital Municipal de Pronto Socorro de Porto Alegre - Porto Alegre (RS), Brasil.,Unidade de Emergência Pediátrica, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Jefferson Pedro Piva
- Serviço de Emergência e Medicina Intensiva Pediátrica, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Departamento de Pediatria, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Leandra Rech
- Programa de Residência em Pediatria e Terapia Intensiva, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Unidade de Terapia Intensiva Pediátrica, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Tamires Goulart Brondani
- Programa de Terapia Intensiva Pediátrica, Hospital da Criança Santo Antônio - Porto Alegre (RS), Brasil
| |
Collapse
|
13
|
Miller AC, Ferrada PA, Kadri SS, Nataraj-Bhandari K, Vahedian-Azimi A, Quraishi SA. High-Frequency Ventilation Modalities as Salvage Therapy for Smoke Inhalation-Associated Acute Lung Injury: A Systematic Review. J Intensive Care Med 2017. [PMID: 28651475 DOI: 10.1177/0885066617714770] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Smoke inhalation-associated acute lung injury (SI-ALI) is a major cause of morbidity and mortality in victims of fire tragedies. To date, there are no evidence-based guidelines on ventilation strategies in acute respiratory distress syndrome (ARDS) after smoke inhalation. We reviewed the existing literature for clinical studies of salvage mechanical ventilation (MV) strategies in patients with SI-ALI, focusing on mortality and pneumonia as outcomes. METHODS A systematic search was designed in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Risk of bias assessment was performed using the Newcastle-Ottawa Quality Assessment Scale (NOS; 0 to 9 stars), with a score ≥7 being the threshold for inclusion in the meta-analysis. A systematic search strategy was used to search 10 databases. Clinical studies were included in which patients: (1) experienced smoke inhalation, (2) treated with MV, and (3) described a concurrent or historical control group. RESULTS A total of 226 potentially relevant studies were identified, of which 7 studies on high-frequency percussive ventilation (HFPV) met inclusion criteria. No studies met inclusion for meta-analysis (NOS ≥ 7). In studies comparing HFPV to conventional mechanical ventilation (CMV), mortality and pneumonia incidence improved in 3 studies and remained unchanged in 3 others. No change in ventilator days or ICU length of stay was observed; however, oxygenation and work of breathing improved with HFPV. CONCLUSIONS Mechanical ventilation in patients with SI-ALI has not been well studied. High-frequency percussive ventilation may decrease in-hospital mortality and pneumonia incidence when compared to CMV. The absence of "good" quality evidence precluded meta-analysis. Based upon low-quality evidence, there was a very weak recommendation that HFPV use may be associated with lower mortality and pneumonia rates in patients with SI-ALI. Given SI-ALI's unique underlying pathophysiology, and its potential implications on therapy, randomized controlled studies are required to ensure that patients receive the safest and most effective care. TRIAL REGISTRATION The study was registered with PROSPERO International prospective register of systematic reviews (#47015).
Collapse
Affiliation(s)
- Andrew C Miller
- 1 Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA.,2 Department of Emergency Medicine, West Virginia University, Morgantown, WV, USA
| | - Paula A Ferrada
- 3 Division of Trauma and Critical Care, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Sameer S Kadri
- 1 Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Amir Vahedian-Azimi
- 4 Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sadeq A Quraishi
- 5 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.,6 Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
14
|
Jones SW, Williams FN, Cairns BA, Cartotto R. Inhalation Injury: Pathophysiology, Diagnosis, and Treatment. Clin Plast Surg 2017; 44:505-511. [PMID: 28576239 DOI: 10.1016/j.cps.2017.02.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The classic determinants of mortality from severe burn injury are age, size of injury, delays of resuscitation, and the presence of inhalation injury. Of the major determinants of mortality, inhalation injury remains one of the most challenging injuries for burn care providers. Patients with inhalation injury are at increased risk for pneumonia (the leading cause of death) and multisystem organ failure. There is no consensus among leading burn care centers in the management of inhalation injury. This article outlines the current treatment algorithms and the evidence of their efficacy.
Collapse
Affiliation(s)
- Samuel W Jones
- Department of Surgery, North Carolina Jaycee Burn Center, University of North Carolina at Chapel Hill, 3007D Burnett Womack Building, CB 7206, Chapel Hill, NC 27599-7206, USA.
| | - Felicia N Williams
- Department of Surgery, North Carolina Jaycee Burn Center, University of North Carolina at Chapel Hill, 3007D Burnett Womack Building, CB 7206, Chapel Hill, NC 27599-7206, USA
| | - Bruce A Cairns
- Department of Surgery, North Carolina Jaycee Burn Center, University of North Carolina at Chapel Hill, 3007D Burnett Womack Building, CB 7206, Chapel Hill, NC 27599-7206, USA
| | - Robert Cartotto
- Department of Surgery, Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Room D712, 1075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| |
Collapse
|