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Coletta F, Pirolli R, Annunziata R, Nugnes M, Tommasello A, Villani R, Giaccari LG, Passavanti MB, Pace MC, Sansone P. Efficacy and Adverse Effects of IV Morphine for Burn Pain Management in the Emergency Department: An Observational Study. Pain Ther 2024; 13:857-864. [PMID: 38795311 PMCID: PMC11254875 DOI: 10.1007/s40122-024-00595-5] [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: 12/12/2023] [Accepted: 03/18/2024] [Indexed: 05/27/2024] Open
Abstract
INTRODUCTION The management of pain following a burn is extremely complex because of the multifactorial nature of burn pain (nociceptive and neuropathic). In the pre-hospital setting and emergency department (ED), the main goal of acute pain management is to reduce the patient's pain, allowing them to maintain function and to prevent the chronification of pain. Opioids are used as first-line treatment in management of burn pain. The aim of our study was to evaluate the efficacy and adverse effects of intravenous (IV) morphine for burn pain management in the ED and to evaluate pain management in the pre-hospital setting. METHODS In this single-center observational study, patients presenting with second- and third-degree burns were enrolled in our ED. Numerical Rating Scale (NRS) and Burn Specific Pain Anxiety Scale (BSPAS) were performed at ED admission and after 1 h. Pain medications administered before arrival in the ED were reported by the rescue team. All patients received IV acetaminophen every 8 h and IV morphine according NRS. RESULTS Thirty patients were included in this study. At the time of arrival to the ED, > 90% of the patients reported severe pain; 95.8% of them received IV morphine to achieve pain relief. After 1 h, > 65% of patients had NRS < 3. The total amount of IV morphine was 18.12 ± 4.26 mg in the first hour. No adverse events were recorded. The BSPAS on admission to the ED was 34.8 ± 5.6, indicating severe anxiety. After 1 h, BSPAS was 12.8 ± 4.8, indicating mild anxiety. CONCLUSION IV morphine used for burn pain management in the emergency setting significantly improves patient outcomes in terms of pain. IV morphine also reduced anxiety scores at 1 h.
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Affiliation(s)
- Francesco Coletta
- Emergency and Acceptance Department, Anesthesia, Emergency and Burn Intensive Care Unit, "A.O.R. N. A. Cardarelli", Naples, Italy
| | - Rossella Pirolli
- Emergency and Acceptance Department, Anesthesia, Emergency and Burn Intensive Care Unit, "A.O.R. N. A. Cardarelli", Naples, Italy
| | - Raffaele Annunziata
- Emergency and Acceptance Department, Anesthesia, Emergency and Burn Intensive Care Unit, "A.O.R. N. A. Cardarelli", Naples, Italy
| | - Manuela Nugnes
- Emergency and Acceptance Department, Anesthesia, Emergency and Burn Intensive Care Unit, "A.O.R. N. A. Cardarelli", Naples, Italy
| | - Antonio Tommasello
- Emergency and Acceptance Department, Anesthesia, Emergency and Burn Intensive Care Unit, "A.O.R. N. A. Cardarelli", Naples, Italy
| | - Romolo Villani
- Emergency and Acceptance Department, Anesthesia, Emergency and Burn Intensive Care Unit, "A.O.R. N. A. Cardarelli", Naples, Italy
| | - Luca Gregorio Giaccari
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, Naples, Italy.
| | - Maria Beatrice Passavanti
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, Naples, Italy
| | - Maria Caterina Pace
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, Naples, Italy
| | - Pasquale Sansone
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, Naples, Italy
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Pedroza A, Fleishhacker Z, Aguillon Paulsen A, Ong JE, Ronkar N, Weigel I, Janecek T, Galet C, Wibbenmeyer L. Subhypnotic Intravenous Ketamine Improves Patient Satisfaction With Burn Wound Care: A Quality Improvement Project. J Burn Care Res 2024; 45:771-776. [PMID: 38165669 PMCID: PMC11073575 DOI: 10.1093/jbcr/irad204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Indexed: 01/04/2024]
Abstract
Despite advancements in pain management for burn injuries, analgesia often fails to meet our patients' needs. We hypothesized that low doses of intravenous (IV) ketamine as an adjunct to our current protocol would be safe, improving both nurse and patient satisfaction with analgesia during hydrotherapy. Burn patients admitted who underwent hydrotherapy from June 1, 2021, to June 30, 2023 were surveyed. Ketamine was administered with the standard opioid-midazolam regimen. Demographics, oral morphine equivalents, midazolam, ketamine doses and time of administration, and adverse events were collected. Patient and nurse satisfaction scores were collected. The ketamine and no-ketamine groups were compared. P < .05 was considered significant. Eighty-five hydrotherapies were surveyed, 47 without ketamine, and 38 with ketamine. Demographics, comorbidities, %TBSA, and hospital length of stay were not different. The median amount of ketamine given was 0.79 mg/kg [0.59-1.06]. Patients who received ketamine were more likely to receive midazolam (100% vs 61.7%; P < .001), and both oral and IV opioids (94.7% vs 68.1%; P = .002) prior to hydrotherapy and less likely to receive rescue opioids or midazolam during hydrotherapy. Two patients in the ketamine group had hypertension (defined as SBP > 180) that did not require treatment. Nurses tended to be more satisfied with patient pain control when ketamine was used (10 [8-10] vs 9 [7-10], P = .072). Patient satisfaction was higher in the ketamine group (10 [8.8-10] vs 9 [7-10], P = .006). Utilizing subhypnotic dose of IV ketamine for hydrotherapy is safe and associated with increased patient satisfaction.
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Affiliation(s)
- Albert Pedroza
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | | | - Alba Aguillon Paulsen
- Division of Acute Care Surgery, Department of Surgery, University of Iowa, Iowa City, IA 52242, USA
| | - Jia Ern Ong
- Division of Acute Care Surgery, Department of Surgery, University of Iowa, Iowa City, IA 52242, USA
| | - Nicolas Ronkar
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Isaac Weigel
- Division of Acute Care Surgery, Department of Surgery, University of Iowa, Iowa City, IA 52242, USA
| | - Trinity Janecek
- Division of Acute Care Surgery, Department of Surgery, University of Iowa, Iowa City, IA 52242, USA
| | - Colette Galet
- Division of Acute Care Surgery, Department of Surgery, University of Iowa, Iowa City, IA 52242, USA
| | - Lucy Wibbenmeyer
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Division of Acute Care Surgery, Department of Surgery, University of Iowa, Iowa City, IA 52242, USA
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Hill DM, Reger M, Todor LA, Boyd AN, Cogle S, DeWitt A, Drabick Z, Faris J, Zavala S, Adams B, Alexander KM, Carter K, Gayed RM, Gutenschwager DW, Hall A, Hansen M, Krantz EN, Pham F, Quan AN, Smith L, Tran N, Walroth TA, Mueller SW. An Appraisal of Pharmacotherapy-Pertinent Literature Published in 2021 and 2022 for Clinicians Caring for Patients With Thermal or Inhalation Injury. J Burn Care Res 2024; 45:614-624. [PMID: 38285011 DOI: 10.1093/jbcr/irae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Indexed: 01/30/2024]
Abstract
Studies focusing on pharmacotherapy interventions to aid patients after thermal injury are a minor focus in burn injury-centered studies and published across a wide array of journals, which challenges those with limited resources to keep their knowledge current. This review is a renewal of previous years' work to facilitate extraction and review of the most recent pharmacotherapy-centric studies in patients with thermal and inhalation injury. Twenty-three geographically dispersed, board-certified pharmacists participated in the review. A Medical Subject Heading-based, filtered search returned 2336 manuscripts over the previous 2-year period. After manual review, 98 (4%) manuscripts were determined to have a potential impact on current pharmacotherapy practice. The top 10 scored manuscripts are discussed. Only 17% of those reviewed were assessed to likely have little effect on current practice. The overall impact of the current cohort was higher than previous editions of this review, which is encouraging. There remains a need for investment in well-designed, high-impact, pharmacotherapy-pertinent research for patients sustaining thermal or inhalation injuries.
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Affiliation(s)
- David M Hill
- Department of Pharmacy, Regional One Health, Memphis, TN 38139, USA
| | - Melissa Reger
- Department of Pharmacy, Community Regional Medical Center, Fresno, CA 93721, USA
| | - Lorraine A Todor
- Department of Pharmacy, Regional One Health, Memphis, TN 38139, USA
| | - Allison N Boyd
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN 46202, USA
| | - Sarah Cogle
- Pharmacy Clinical Programs, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Alexandra DeWitt
- Department of Pharmacy, University Medical Center New Orleans, New Orleans, LA 70112, USA
| | - Zachary Drabick
- Department of Pharmacy, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Janie Faris
- Department of Pharmacy, Parkland Health & Hospital System, Dallas, TX 35235, USA
| | - Sarah Zavala
- Department of Pharmacy, Jesse Brown VA Medical Center, Chicago, IL 60612, USA
| | - Beatrice Adams
- Department of Pharmacy, Tampa General Hospital, Tampa, FL 33606, USA
| | - Kaitlin M Alexander
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL 32610, USA
| | - Kristen Carter
- Department of Pharmacy, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA
| | - Rita M Gayed
- Department of Pharmacy and Medical Nutrition, Grady Burn Center, Atlanta, GA 71644, USA
| | | | - Alexandria Hall
- Department of Pharmacy, Harborview Medical Center, Seattle, WA 98104, USA
| | - Meaghan Hansen
- Department of Pharmacy, UPMC Mercy, Pittsburgh, PA 15219, USA
| | - Erica N Krantz
- Department of Pharmacy, Ascension Via Christi, Wichita, KS 67214, USA
| | - Felix Pham
- Department of Pharmacy, Torrance Memorial Medical Center, Torrance, CA 90505, USA
| | - Asia N Quan
- Department of Pharmacy, The Arizona Burn Center Valleywise Health, Phoenix, AZ 85008, USA
| | - Lisa Smith
- Department of Pharmacy, Doctors Hospital, Augusta, GA 30909, USA
| | - Nicolas Tran
- Department of Pharmacy, Tampa General Hospital, Tampa, FL 33606, USA
| | - Todd A Walroth
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN 46202, USA
| | - Scott W Mueller
- Department of Pharmacy, University of Colorado Health, Aurora, CO 80045, USA
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Werner E. The use of virtual reality as a standard of care in verified burn centers. Burns 2024; 50:808-812. [PMID: 38336495 DOI: 10.1016/j.burns.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/26/2023] [Accepted: 01/10/2024] [Indexed: 02/12/2024]
Abstract
This study explored whether the use of virtual reality (VR) was a standard of care during burn care at burn verified facilities in the United States. Surveys were sent to American Burn Association verified burn centers to investigate if VR was being used as a standard of care, if protocols for using VR are in place and how they were developed, and what barriers these facilities are facing and several other topics investigated. Out of the 64 facilities surveyed, 21 responses were collected. Burn facilities reported 63.2% do not use and 36.8% do use VR while performing burn dressing changes and debridement. Only one out of seven respondents who reported they use VR considered it a standard of practice at their facility. Out of the seven hospitals currently using VR, two reported a decrease in opioid use with burn care with the use of VR. Although the current results indicate that VR is not frequently used clinically during burn care at most burn centers, 83.3% of burn centers reported they see themselves using VR in the future. As VR becomes more widely disseminated, future research should be conducted to continue to see if VR is becoming a standard of care and whether VR is making clinical impacts on pain, opioid use, and level of anxiety among burn patients.
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Fleishhacker Z, Pedroza A, Ong JE, Ronkar N, Weigel I, Janecek T, Wellsandt SA, Galet C, Wibbenmeyer L. Optimizing burn wound procedural pain control, efficiency, and satisfaction through integrated nurse and physician education. Burns 2024; 50:702-708. [PMID: 38114378 PMCID: PMC10999346 DOI: 10.1016/j.burns.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/29/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
Herein, we report the results of a quality improvement project (QI). Following a review of the burn unit practices, a nursing-led, physician supported educational intervention regarding optimal timing, dosage, and indication for medications used during hydrotherapy, including midazolam and opioids, was implemented. We hypothesized that such intervention would support improvement in both nurse and patient satisfaction with pain control management. Patients undergoing hydrotherapy were surveyed. Demographics, opioid dose prescribed (oral morphine equivalents), midazolam use, timing of administration, and adverse events were collected. Patient pain scores (1-10) before and after hydrotherapy and patient and nurse satisfaction scores (1-10) after hydrotherapy were collected. The pre- and post-education populations were compared. P < 0.05 was considered significant. Post-education, administration of opioids (59.1% v. 0%, p < 0.001) and midazolam (59.1% vs. 10.4%; p < 0.001) prior to hydrotherapy significantly improved, leading to fewer patients requiring rescue opioids during hydrotherapy (25% vs. 74%, p < 0.001). Hydrotherapy duration significantly decreased post-education (19 [13.3-30] min vs. 32 [18-43] min, p = 0.003). Nurses' ratings of their patient's pain control (9 [7.3-10] vs. 7.5 [6-9], p = 0.004) and ease of procedure (10 [9,10] vs. 9 [7.8-10], p = 0.037) significantly improved. Patients' pain management satisfaction rating did not change, but the number of subjects rating their pain management as excellent tended to increase (36.4% vs. 20%, p = 0.077). Nursing led, physician supported, education can improve medication administration prior to and during hydrotherapy, increasing the ease of the procedure as well as staff satisfaction.
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Affiliation(s)
- Zachary Fleishhacker
- Carver College of Medicine, Department of Surgery University of Iowa, Iowa City, IA, USA
| | - Albert Pedroza
- Carver College of Medicine, Department of Surgery University of Iowa, Iowa City, IA, USA
| | - Jia Ern Ong
- Acute Care Surgery Division, Department of Surgery University of Iowa, Iowa City, IA, USA
| | - Nicolas Ronkar
- Carver College of Medicine, Department of Surgery University of Iowa, Iowa City, IA, USA
| | - Isaac Weigel
- Acute Care Surgery Division, Department of Surgery University of Iowa, Iowa City, IA, USA
| | - Trinity Janecek
- Acute Care Surgery Division, Department of Surgery University of Iowa, Iowa City, IA, USA
| | - Sarah A Wellsandt
- Acute Care Surgery Division, Department of Surgery University of Iowa, Iowa City, IA, USA
| | - Colette Galet
- Acute Care Surgery Division, Department of Surgery University of Iowa, Iowa City, IA, USA.
| | - Lucy Wibbenmeyer
- Acute Care Surgery Division, Department of Surgery University of Iowa, Iowa City, IA, USA
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Kowalski G, Leppert W, Domagalska M, Grochowicka M, Teżyk A, Słowiński K, Bienert A, Szkutnik-Fiedler D, Wieczorowska-Tobis K. Analgesic Efficacy of Oxycodone in Postoperative Dressings after Surgical Treatment of Burn Wounds: A Randomised Controlled Trial. J Clin Med 2024; 13:784. [PMID: 38337478 PMCID: PMC10856020 DOI: 10.3390/jcm13030784] [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: 12/28/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION This study aimed to assess the analgesic efficacy of oxycodone at doses of 10 mg and 20 mg in dressings after surgery of burn wounds. MATERIAL AND METHODS Twenty adult patients who underwent surgical treatment of third-degree burn wounds under general anaesthesia were included. Burn wounds were treated with dressings, to which oxycodone was added at 20 mg in Group 1 and 10 mg in Group 2. After the surgery, plasma oxycodone and noroxycodone concentrations were assayed, and pain intensity was assessed with Numerical Rating Scale (NRS). RESULTS In Group 1, no patient reported pain; in Group 2, four patients reported pain. The pain intensity, according to NRS, was 1-8. Plasma concentration of oxycodone in the blood serum was in the range of 1.24-3.15 ng/mL and 1.09-1.28 ng/mL in Group 1 and Group 2, respectively. Noroxycodone was not detected in the plasma. Adverse effects were not observed in any of the treated patients. CONCLUSIONS Oxycodone in dressings provides patients with adequate and safe analgesia.
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Affiliation(s)
- Grzegorz Kowalski
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Pozan, Poland; (G.K.); (M.G.); (K.W.-T.)
- Department of Anesthesiology, Józef Struś Multiprofile Municipal Hospital, 61-701 Poznań, Poland
| | - Wojciech Leppert
- Department of Palliative Medicine, Institute of Medical Sciences Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, Poland;
- University Clinical Hospital in Poznań, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Małgorzata Domagalska
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Pozan, Poland; (G.K.); (M.G.); (K.W.-T.)
| | - Monika Grochowicka
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Pozan, Poland; (G.K.); (M.G.); (K.W.-T.)
| | - Artur Teżyk
- Department of Forensic Medicine, Poznan University of Medical Sciences, 61-701 Poznań, Poland;
| | - Krzysztof Słowiński
- Department of Trauma, Burns and Plastic Surgery, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | - Agnieszka Bienert
- Chair and Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (A.B.); (D.S.-F.)
| | - Danuta Szkutnik-Fiedler
- Chair and Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (A.B.); (D.S.-F.)
| | - Katarzyna Wieczorowska-Tobis
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-701 Pozan, Poland; (G.K.); (M.G.); (K.W.-T.)
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Jeffs DA, Spray BJ, Baxley L, Braden E, Files A, Marrero E, Teague T, Teo E, Yelvington M. Comparing novel virtual reality and nursing standard care on burn wound care pain in adolescents: A randomized controlled trial. J SPEC PEDIATR NURS 2024; 29:e12419. [PMID: 38095116 DOI: 10.1111/jspn.12419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE This study compared the effectiveness of age-appropriate, high technology, interactive virtual reality (VR) distraction with standard care (SC) provided by the nurse on adolescents' acute procedural pain intensity perception during burn wound care treatment in the ambulatory clinic setting. DESIGN This randomized controlled trial included 43 adolescents ages 10-21 from the ambulatory burn clinic of a large children's hospital. METHODS Blinded study participants were randomly assigned to either VR or SC (non-significantly different, current mean burn surface area, 1.3 and 1.7, respectively) during the first burn wound care procedure in the burn clinic. Blinded research staff collected pre-procedure data including Spielberger's State-Trait Anxiety Inventory and postprocedure wound care pain intensity using the Adolescent Pediatric Pain Tool. A total of 41 participants completed all study procedures. RESULTS No statistically significant difference in burn wound care procedural pain was noted between the VR and SC groups after adjusting for several factors. Pre-procedure state and trait anxiety correlated with reported pre-procedure pain. Wound care pain was found to be significantly associated with pre-wound care pain score, time from original burn to clinic burn care treatment, and length of wound care treatment. These factors accounted for approximately 45% of the variation in pain scores during wound care treatment. PRACTICE IMPLICATIONS VR distraction can be a useful pain management strategy but may not take the place of the unique nurse-patient relationship that occurs during clinical encounters. Tailoring pain management during burn wound care requires consideration of anxiety, time from the burn injury to the wound care procedure, length of time of the wound care procedure, and pretreatment pain level. Knowing patients' needs, desires, and temperaments along with the specifics about the healthcare procedures are critical to formulating individualized care plans that may or may not include VR. Newer technology, such as easier-to-use, less expensive VR, may assist with translation into practice making its clinical use more routine.
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Affiliation(s)
| | - Beverly J Spray
- Arkansas Children's Research Institute, Little Rock, Arkansas, USA
| | - Lauren Baxley
- Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Eric Braden
- Arkansas Children's, Little Rock, Arkansas, USA
| | - Amber Files
- Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | | | - Tiffany Teague
- Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Esther Teo
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Burn Surgery, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Miranda Yelvington
- Rehabilitation Services, Arkansas Children's Hospital, Little Rock, Arkansas, USA
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Villarreal E, Wolf SE, Golovko G, Bagby S, Wermine K, Gotewal S, Obi A, Corona K, Huang L, Keys P, Song J, El Ayadi A. Opioid prescription and opioid disorders in burns: A large database analysis from 1990 to 2019. Burns 2023; 49:1845-1853. [PMID: 37872016 DOI: 10.1016/j.burns.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/28/2023] [Accepted: 09/20/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Opioids remain crucial in the management of burn pain. A comprehensive analysis of opioid use in burns and their complications has not been investigated. METHODS Data were collected from TriNetX, a large multicenter database with de-identified patient information. The population included patients prescribed opioids on or following burn injury from January 1st, 1990, to December 31st, 2019. Opioid prescription use was analyzed after cohort stratification by decades: 1990-1999, 2000-2009, and 2010-2019. Outcomes for opioid-related disorders, opioid dependence, opioid abuse, intentional self-harm, and mental and behavioral disorders from psychoactive substance use were investigated. RESULTS Hydrocodone was the most frequently prescribed opioid in 1990-1999 and 2000-2009, with oxycodone taking the lead in 2010-2019 (p < 0.0001). During 1990-1999, patients had a decreased risk of recorded opioid-related disorders (RR=0.52), opioid dependence (RR=0.46), opioid abuse (RR=0.55), mental and behavioral disorders (RR=0.88), and intentional self-harm (RR=0.37) when compared to 2000-2009. A comparison of the 2000-2009-2010-2019 cohorts showed an increased risk of recorded opioid-related disorders (RR= 1.91), opioid dependence (RR=1.56), opioid abuse (RR=1.67), mental and behavioral disorders (RR =1.73), and intentional self-harm (RR=2.02). CONCLUSIONS The risk of opioid-related disorders has nearly doubled since the year 2000 warranting precautions when prescribing pain medications to burn patients.
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Affiliation(s)
- Elvia Villarreal
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - George Golovko
- Department of Pharmacology, University of Texas Medical Branch, Galveston, TX, USA
| | - Shelby Bagby
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Kendall Wermine
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Sunny Gotewal
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Ann Obi
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Kassandra Corona
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Lyndon Huang
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Phillip Keys
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Juquan Song
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
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Radzikowska-Büchner E, Łopuszyńska I, Flieger W, Tobiasz M, Maciejewski R, Flieger J. An Overview of Recent Developments in the Management of Burn Injuries. Int J Mol Sci 2023; 24:16357. [PMID: 38003548 PMCID: PMC10671630 DOI: 10.3390/ijms242216357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
According to the World Health Organization (WHO), around 11 million people suffer from burns every year, and 180,000 die from them. A burn is a condition in which heat, chemical substances, an electrical current or other factors cause tissue damage. Burns mainly affect the skin, but can also affect deeper tissues such as bones or muscles. When burned, the skin loses its main functions, such as protection from the external environment, pathogens, evaporation and heat loss. Depending on the stage of the burn, the patient's condition and the cause of the burn, we need to choose the most appropriate treatment. Personalization and multidisciplinary collaboration are key to the successful management of burn patients. In this comprehensive review, we have collected and discussed the available treatment options, focusing on recent advances in topical treatments, wound cleansing, dressings, skin grafting, nutrition, pain and scar tissue management.
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Affiliation(s)
- Elżbieta Radzikowska-Büchner
- Department of Plastic, Reconstructive and Maxillary Surgery, National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137 Street, 02-507 Warszawa, Poland;
| | - Inga Łopuszyńska
- Department of Plastic, Reconstructive and Maxillary Surgery, National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137 Street, 02-507 Warszawa, Poland;
| | - Wojciech Flieger
- Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4 Street, 20-090 Lublin, Poland;
| | - Michał Tobiasz
- Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, Krasnystawska 52 Street, 21-010 Łęczna, Poland;
| | - Ryszard Maciejewski
- Faculty of Medicine, University of Warsaw, Żwirki i Wigury 101 Street, 02-089 Warszawa, Poland;
| | - Jolanta Flieger
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4A Street, 20-093 Lublin, Poland
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10
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Gu R, Zhou H, Zhang Z, Lv Y, Pan Y, Li Q, Shi C, Wang Y, Wei L. Research progress related to thermosensitive hydrogel dressings in wound healing: a review. NANOSCALE ADVANCES 2023; 5:6017-6037. [PMID: 37941954 PMCID: PMC10629053 DOI: 10.1039/d3na00407d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/27/2023] [Indexed: 11/10/2023]
Abstract
Wound healing is a dynamic and complex process in which the microenvironment at the wound site plays an important role. As a common material for wound healing, dressings accelerate wound healing and prevent external wound infections. Hydrogels have become a hot topic in wound-dressing research because of their high water content, good biocompatibility, and adjustable physical and chemical properties. Intelligent hydrogel dressings have attracted considerable attention because of their excellent environmental responsiveness. As smart polymer hydrogels, thermosensitive hydrogels can respond to small temperature changes in the environment, and their special properties make them superior to other hydrogels. This review mainly focuses on the research progress in thermosensitive intelligent hydrogel dressings for wound healing. Polymers suitable for hydrogel formation and the appropriate molecular design of the hydrogel network to achieve thermosensitive hydrogel properties are discussed, followed by the application of thermosensitive hydrogels as wound dressings. We also discuss the future perspectives of thermosensitive hydrogels as wound dressings and provide systematic theoretical support for wound healing.
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Affiliation(s)
- Ruting Gu
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University Qingdao 266000 China
| | - Haiqing Zhou
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University Qingdao 266000 China
| | - Zirui Zhang
- Emergency Departments, The Affiliated Hospital of Qingdao University Qingdao 266000 China
| | - Yun Lv
- School of Nursing, Qingdao University Qingdao 266000 China
| | - Yueshuai Pan
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University Qingdao 266000 China
| | - Qianqian Li
- Ophthalmology Department, The Affiliated Hospital of Qingdao University Qingdao 266000 China
| | - Changfang Shi
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University Qingdao 266000 China
| | - Yanhui Wang
- Department of Oral Implantology, The Affiliated Hospital of Qingdao University Qingdao 266000 China
| | - Lili Wei
- Office of the Dean, The Affiliated Hospital of Qingdao University Qingdao 266000 China
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11
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Twichell M. Inpatient Rehabilitation Following Burn Injury. Phys Med Rehabil Clin N Am 2023; 34:755-765. [PMID: 37806695 DOI: 10.1016/j.pmr.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Inpatient rehabilitation confers excellent benefit to burn survivors and should be considered as a potential destination during discharge planning. Consulting physiatrists identify and manage complications within the inpatient rehabilitation setting. Interventions can be taken to address medical sequelae of injury, including pain, itch, neuropathy, psychological coping and mood, and nutritional needs. Physiatrists also oversee and direct a rehabilitation program focusing on scar management, contracture prevention, dysphagia treatment, and evaluation and treatment of cognitive impairments. Aerobic and resistive exercise are key components of an inpatient rehabilitation program to reduce the systemic impact of a burn injury and improve quality of life.
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Affiliation(s)
- Maria Twichell
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Suite 910, Pittsburgh, PA 15213, USA.
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12
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Turner E, Robinson DM, Roaten K. Psychological Issues. Phys Med Rehabil Clin N Am 2023; 34:849-866. [PMID: 37806702 DOI: 10.1016/j.pmr.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Psychological distress is common following a burn injury, and many burn survivors have pre-morbid psychiatric illnesses including mood and trauma-related disorders, and substance and alcohol use. This article is intended to be used by all interdisciplinary health care team members to improve the identification and treatment of common psychological concerns experienced by survivors and is organized to follow the general recovery timeline.
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Affiliation(s)
- Emma Turner
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Suite CS6.104B, Dallas, TX 75390, USA.
| | - Diana M Robinson
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Suite CS6.104B, Dallas, TX 75390, USA.
| | - Kimberly Roaten
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Suite CS6.104B, Dallas, TX 75390, USA.
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13
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O'Neil A, Hines D, Wirdzek E, Thornburg C, Murray D, Porter J. Early Mobilization, Early Ambulation, and Burn Therapy in the Acute Hospital Setting. Phys Med Rehabil Clin N Am 2023; 34:733-754. [PMID: 37806694 DOI: 10.1016/j.pmr.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Rehabilitation therapies in the burn acute care environment continue to evolve. Immediate access to therapy is considered standard, and therapy is a key component of the transprofessional care team. Early positioning, edema management, and therapy care in the intensive care unit (ICU) environment can limit later complications; mobility in the ICU can be engaged safely using a systems-based approach in the absence of nondirectable agitation. Later in the course of acute care, early ambulation is an appropriate intervention that can improve outcomes.
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Affiliation(s)
- Audrey O'Neil
- Burn Rehabilitation Services; Eskenazi Health, Richard M Fairbanks Burn Center, 720 Eskenazi Avenue, 4th Floor, Indianapolis, IN 46202, USA
| | - Danika Hines
- Burn Therapy, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
| | - Emily Wirdzek
- Burn Therapy, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
| | - Cody Thornburg
- Burn Therapy, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
| | - Derek Murray
- Burn Therapy, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA.
| | - John Porter
- Physiatry, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA; Trauma and Burn Services, Department of Surgery, University of Arizona, Creighton University, Phoenix, AZ, USA
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14
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Sahin AT, Sahin SY. Influence of burn specific pain anxiety on pain experienced during wound care in adult outpatients with burns. Burns 2023; 49:1335-1343. [PMID: 36604278 DOI: 10.1016/j.burns.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
Burn pain is known as the most difficult type of pain to manage. In order to improve patient outcomes, nurses must be aware of burn pain and the conditions that affect it. This study aimed to evaluate the influence of burn-specific pain anxiety on pain experienced by adult outpatients with burns during burn wound care. This was a single-center, prospective, and descriptive study. The study was conducted with 60 adult outpatients with burns between March 2021 and April 2021 in a burn centers' outpatient service in Ankara. Personal information form, burn-specific pain anxiety scale, numerical rating scale, and verbal category scale were used for data collection. The mean age of the patients was 38.50 ± 14.27 years, and 53.33% patients were females. The primary cause of burns was home accidents (80%), and patients generally suffered from scalding-type burns (73.33%). This study demonstrated that the patients reported high pain anxiety associated with burns (59.85 ± 15.71), the mean pain score experienced during wound care was 6.33 ± 2.14 and the pain was primarily classified as disturbing (35%) based on the verbal category scale. In this study, it was found that burn-specific pain anxiety affects the pain experienced during burn wound care in adults receiving outpatient treatment. Hence, nurses should provide effective pain management to patients with burn injuries. In addition, the inclusion of anxiety-reducing practices in the care plans of such patients is recommended, and further studies are needed to identify and meet the care needs of patients with severe burns.
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Affiliation(s)
- Ayse Tugce Sahin
- Department of Surgical Nursing, Gülhane Faculty of Nursing, University of Health Sciences, Ankara, Turkey.
| | - Sibel Yilmaz Sahin
- Department of Surgical Nursing, Gülhane Faculty of Nursing, University of Health Sciences, Ankara, Turkey.
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15
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Pruskowski KA, Feth M, Hong L, Wiggins AR. Pharmacologic Management of Pain, Agitation, and Delirium in Burn Patients. Surg Clin North Am 2023; 103:495-504. [PMID: 37149385 DOI: 10.1016/j.suc.2023.02.003] [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: 05/08/2023]
Abstract
The majority of hospitalized burn patients experience pain, agitation, and delirium. The development of each one of these conditions can also lead to, or worsen, the others. Providers, therefore, need to thoroughly assess the underlying issue to determine the most effective treatment. Multimodal pharmacologic regimens are often used in conjunction with non-pharmacologic strategies to manage pain, agitation, and delirium. This review focuses on the pharmacologic management of these complicated patients in a critical-care setting.
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Affiliation(s)
- Kaitlin A Pruskowski
- US Army Institute of Surgical Research, 3698 Chambers Pass, ATTN: FCMR-SRT, JBSA Fort Sam, Houston, TX 78234, USA; Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Maximilian Feth
- US Army Institute of Surgical Research, 3698 Chambers Pass, ATTN: FCMR-SRT, JBSA Fort Sam, Houston, TX 78234, USA; Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Federal Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Linda Hong
- US Army Institute of Surgical Research, 3698 Chambers Pass, ATTN: FCMR-SRT, JBSA Fort Sam, Houston, TX 78234, USA
| | - Amanda R Wiggins
- US Army Institute of Surgical Research, 3698 Chambers Pass, ATTN: FCMR-SRT, JBSA Fort Sam, Houston, TX 78234, USA
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16
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Liechty KL, Shields K, Ogden E, Eshraghi N, Dedeo M, Bishop P. A Multimodal Pain Management Strategy for Burn Patients. Pain Manag Nurs 2023; 24:44-51. [PMID: 36319550 DOI: 10.1016/j.pmn.2022.09.006] [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] [Received: 04/17/2022] [Revised: 08/02/2022] [Accepted: 09/24/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acute burn pain is difficult to manage, and poorly managed pain can lead to deleterious consequences such as post-traumatic stress disorder, prolonged recovery, chronic pain and long-term dependence on opioids. Understanding the role of nursing in promoting self-efficacy and minimizing opioid use is valuable. It is unknown whether strategic efforts aimed at enhancing patient self-efficacy will improve pain managment and lessen opioid requirements in the adult burn population. AIM The aim of this study was to examine the effect of a multi-modal, interdisciplinary pain management strategy on coping self-efficacy, pain scores, and opioid use in adult burn patients in the acute care setting. METHOD A quasi-experimental pre-test/post-test design was employed in an American Burn Association (ABA) verified burn center in the Pacific Northwestern United States. Data were collected prospectively for a 6-month period on 44 burn patients. The comparison group received usual care (n = 28), and the intervention received a pain management protocol (n = 16). Coping self-efficacy was measured on admission and at discharge in both groups using the Coping Self-Efficacy Scale. Numeric pain scores and opioid use in morphine milligram equivalents were averaged for each participant. Burn nurse perceptions were gathered via an anonymous electronic survey post data collection in February 2021. RESULTS There were no significant differences in measured coping self-efficacy, pain scores, or opioid use between the intervention and comparison groups. A significant positive correlation was found between length of stay, size of burn, and coping self-efficacy and problem focused self-efficacy. Burn nurses reported increased use of nonpharmacologic adjuncts since protocol implementation. CONCLUSION Nonpharmacologic adjuncts are more likely to be used consistently when protocolized. There is also evidence to support that certain aspects of self-efficacy may be enhanced during acute phase of burn care.
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Affiliation(s)
- Kara L Liechty
- Legacy Good Samaritan Pain Management Center, Portland, Oregon; Legacy Emanuel Oregon Burn Center, Portland, Oregon.
| | - Kelly Shields
- Legacy Health, Portland, Oregon; Legacy Emanuel Oregon Burn Center, Portland, Oregon
| | - Emily Ogden
- Legacy Emanuel Oregon Burn Center, Portland, Oregon
| | - Niknam Eshraghi
- Legacy Emanuel Oregon Burn Center, Portland, Oregon; General Surgery & Burn Specialists, Portland, OR
| | - Michelle Dedeo
- Providence Swedish, Seattle, Washington; Old Dominion University, Virginia Beach, Virginia
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17
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DeJesus J, Shah NR, Franco-Mesa C, Walters ET, Palackic A, Wolf SE. Risk factors for opioid use disorder after severe burns in adults. Am J Surg 2023; 225:400-407. [PMID: 36184330 DOI: 10.1016/j.amjsurg.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/09/2022] [Accepted: 09/18/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Risk factors for opioid dependence amongst burn patients have not been well-explored compared to other surgical fields. METHODS The TrinetX database was queried for patients diagnosed with opioid use disorder (OUD) after thermal or chemical burn. Propensity score matching was performed. Opioid and non-opioid analgesia use, ICU care, surgery, and comparative risks among common opiates were examined using descriptive and univariate regression models, including odds ratios. Subgroup analysis evaluated the impact of multimodal analgesia. RESULTS Odds of receiving IV opioids for acute analgesia (p = <0.0001, OR = 1.80, CI = 1.45-2.25), undergoing surgery (p = <0.0001, OR = 1.58, CI = 1.26-1.98), and ICU care (p = <0.0001, OR = 3.60, CI = 2.00-3.83) after burn injury were higher in patients who developed OUD. Patients receiving multimodal therapy within 24 hours of admission had lower odds of developing OUD (OR = 0.74, CI = 2.76-4.68, p = 0.0001) and chronic pain (OR = 0.89, CI = 0.78-1.00, p = 0.05) regardless of TBSA. CONCLUSION Patients who developed opioid use disorder following burn injury had higher odds of receiving opioid exclusive pain management, more frequent surgery, ICU care.
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Affiliation(s)
- Jana DeJesus
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.
| | - Nikhil R Shah
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.
| | - Camila Franco-Mesa
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.
| | - Elliot T Walters
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.
| | - Alen Palackic
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, 8036, Austria.
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.
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18
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Datta PK, Roy Chowdhury S, Aravindan A, Saha S, Rapaka S. Medical and Surgical Care of Critical Burn Patients: A Comprehensive Review of Current Evidence and Practice. Cureus 2022; 14:e31550. [DOI: 10.7759/cureus.31550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 11/16/2022] Open
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19
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Shiferaw A, Mola S, Gashaw A, Sintayehu A. Evidence-based practical guideline for procedural pain management and sedation for burn pediatrics patients undergoing wound care procedures. Ann Med Surg (Lond) 2022; 83:104756. [DOI: 10.1016/j.amsu.2022.104756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 10/14/2022] Open
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20
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Opioid use disorder in adult burn patients: Implications for future mental health, behavioral and substance use patterns. Burns 2022:S0305-4179(22)00209-1. [DOI: 10.1016/j.burns.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/13/2022] [Accepted: 08/10/2022] [Indexed: 11/02/2022]
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21
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Review of History of Basic Principles of Burn Wound Management. Medicina (B Aires) 2022; 58:medicina58030400. [PMID: 35334576 PMCID: PMC8954035 DOI: 10.3390/medicina58030400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 01/09/2023] Open
Abstract
Thermal energy is an essential and useful resource to humans in modern society. However, a consequence of using heat carelessly is burns. Burn injuries have various causes, such as exposure to flame, radiation, electrical, and chemical sources. In this study, we reviewed the history of burn wound care while focusing on the basic principles of burn management. Through this review, we highlight the need for careful monitoring and customization when treating burn victims at each step of wound care, as their individual needs may differ. We also propose that future research should focus on nanotechnology-based skin grafts, as this is a promising area for further improvement in wound care.
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22
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O'Neil AM, Rush C, Griffard L, Roggy D, Boyd A, Hartman B. 5 -Year Retrospective Analysis of a Vented Mobility Algorithm in the Burn ICU. J Burn Care Res 2022; 43:1129-1134. [PMID: 34978322 DOI: 10.1093/jbcr/irab248] [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: 11/13/2022]
Abstract
Early mobilization with mechanically ventilated patients has received significant attention within recent literature, however limited research has focused specifically on the burn population. The purpose of this single center, retrospective analysis was to review the use of a burn critical care mobility algorithm, to determine safety and feasibility of a burn vented mobility program, share limitations preventing mobility progression at our facility, and discuss unique challenges to vented mobility with intubated burn patients. A retrospective review was completed for all intubated burn center admissions between January 2015 to December 2019. Burn Therapy notes were then reviewed for data collection, during the intubation period, using stages of the mobility algorithm. In 5 years following initial implementation, the vented mobility algorithm was utilized on 127 patients with an average total body surface area of 22.8%. No adverse events occurred. Stage 1 (Range of motion) was completed with 100% of patients (n=127). Chair mode of bed, stage 2a, was utilized in 39.4%(n=50) of patients, while 15.8% (n=20) of patients were dependently transferred to the cardiac chair in stage 2b. Stage 3 (sitting on the edge-of-bed) was completed with 25% (n=32) of patients, with 11% (n=14) progressing to stage 5 (standing), and 3.9% (n=5) actively transferring to a chair. In 5 years, only 4.7% (n=6) reached stage 6 (ambulation). The most common treatment limitations were medical complications (33%) and line placement (21%). Early mobilization during mechanical ventilation is safe and feasible within the burn population, despite challenges including airway stability, sedation, and line limitations.
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Affiliation(s)
| | | | | | - David Roggy
- Richard M Fairbanks Burn Center, Indianapolis, IN
| | - Allison Boyd
- Richard M Fairbanks Burn Center, Indianapolis, IN
| | - Brett Hartman
- Indiana University School of Medicine, Indianapolis, IN
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Sasaki J, Matsushima A, Ikeda H, Inoue Y, Katahira J, Kishibe M, Kimura C, Sato Y, Takuma K, Tanaka K, Hayashi M, Matsumura H, Yasuda H, Yoshimura Y, Aoki H, Ishizaki Y, Isono N, Ueda T, Umezawa K, Osuka A, Ogura T, Kaita Y, Kawai K, Kawamoto K, Kimura M, Kubo T, Kurihara T, Kurokawa M, Kobayashi S, Saitoh D, Shichinohe R, Shibusawa T, Suzuki Y, Soejima K, Hashimoto I, Fujiwara O, Matsuura H, Miida K, Miyazaki M, Murao N, Morikawa W, Yamada S. Japanese Society for Burn Injuries (JSBI) Clinical Practice Guidelines for Management of Burn Care (3rd Edition). Acute Med Surg 2022; 9:e739. [PMID: 35493773 PMCID: PMC9045063 DOI: 10.1002/ams2.739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 01/28/2023] Open
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Efficacy of opioids and non-opioid analgesics in the treatment of post procedure pain of burned patients: a narrative review. Braz J Anesthesiol 2021; 72:637-647. [PMID: 34364900 PMCID: PMC9515665 DOI: 10.1016/j.bjane.2021.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 07/12/2021] [Accepted: 07/20/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Burns are a common trauma that cause acute severe pain in up to 80% of patients. The objective of this narrative review is to evaluate the efficacy of opioids, non-steroidal anti-inflammatory drugs, paracetamol, gabapentinoids, ketamine, and lidocaine in the treatment of acute pain in burn victims. Methodology The databases explored were PubMed, Embase, ClinicalTrials, and OpenGrey. The included randomized, controlled clinical trials assessed the analgesic efficacy of these drugs on hospitalized patients, had no age limit, patients were in the acute phase of the burn injury and were compared to placebo or other analgesic drugs. Studies describing deep sedation, chronic opioid use, chronic pain, and patients taken to reconstructive surgeries were excluded. The Jadad scale was used to evaluate quality. Results Six randomized controlled clinical trials (397 patients) that evaluated the analgesic efficacy of fentanyl (n = 2), nalbuphine (n = 1), ketamine (n = 1), gabapentin (n = 1), and lidocaine (n = 1) to treat post-procedural pain were included. Fentanyl, nalbuphine, and ketamine were effective, while lidocaine was associated with a slight increase in reported pain and gabapentin showed no significant differences. Two studies were of high quality, one was of medium high quality, and three were of low quality. No studies on the efficacy of NSAIDs or paracetamol were found. Conclusion Evidence of efficacy is very limited. Fentanyl, nalbuphine, and ketamine seem to be effective for controlling acute pain in burn patients, whereas gabapentin and lidocaine did not show any efficacy.
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25
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Abali AE, Cabioglu T, Bayraktar N, Ozdemir BH, Moray G, Haberal M. Efficacy of Acupuncture on Pain Mechanisms, Inflammatory Responses, and Wound Healing in the Acute Phase of Major Burns: An Experimental Study on Rats. J Burn Care Res 2021; 43:389-398. [PMID: 34309681 DOI: 10.1093/jbcr/irab142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES We investigated acupuncture, a potential contributor for burn-care, on physiological and pathological pain mechanisms and systemic and local inflammatory responses in a rat experimental burn model. METHODS Forty male Sprague-Dawley rats were divided into 2 groups. One-hour groups(5 rats/group) were observed for 1 hour and included Sh1(sham/observation), ShA1(sham+acupuncture/observation), Brn1(burn/observation), and BrnA1(burn+acupuncture/observation). Seven-day groups(5 rats/group) were observed for 7 days and included Sh7(sham/observation), ShA7(sham+acupuncture/observation), Brn7(burn/observation), and BrnA7(burn+acupuncture/observation). "Pain-distress scores" were noted daily, acupuncture was repeated within every wound-dressing change on alternate days. After observation periods, blood samples for interleukin-6 and beta-endorphin and skin biopsies for inflammatory-changes and immunohistochemical-staining of interleukin-6 were collected for analysis( P< .05 ). RESULTS In 1-hour groups, interleukin-6 accumulation in burn wounds of BrnA1 was less than Brn1, with Brn1 having the highest mean blood level(P< .05). Mean beta-endorphin levels were higher in ShA1, Brn1, and BrnA1 than in Sh1(P< .05). In all 7-day groups, the agonizing period was 48 to72 hours after burn, with Brn7 most affected(P< .05). Microvessels were multiplied in Brn7group, with significantly higher numbers in burn wounds of BrnA7(P˂ .05). Burn wounds of BrnA7 had less accumulation of interleukin-6 than Brn7 with Brn7-group having the highest mean blood level and Sh7, ShA7, and BrnA7 having similarly low levels(P˃ .05). Beta-endorphin levels in ShA7, Brn7, and BrnA7 were lower than in Sh7(P< .05). CONCLUSIONS Acupuncture contributed to management of physiological and pathological pain, modulation of inflammatory responses, and associated enhancement of angiogenesis in acute phase of burn injury in rats.
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Affiliation(s)
- Ayse Ebru Abali
- Department of General Surgery, Faculty of Medicine, Burn and Fire Disasters Institude, Ankara Burn Center, Baskent University
| | - Tugrul Cabioglu
- Department of Physiology, Faculty of Medicine and Acupuncture Unit, Baskent University
| | | | | | - Gokhan Moray
- Department of General Surgery, Faculty of Medicine, Burn and Fire Disasters Institude, Ankara Burn Center, Baskent University
| | - Mehmet Haberal
- Department of General Surgery, Faculty of Medicine, Burn and Fire Disasters Institude, Ankara Burn Center, Baskent University
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26
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El Khatib A, Jeschke MG. Contemporary Aspects of Burn Care. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:386. [PMID: 33923571 PMCID: PMC8073568 DOI: 10.3390/medicina57040386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 02/06/2023]
Abstract
The past one hundred years have seen tremendous improvements in burn care, allowing for decreased morbidity and mortality of this pathology. The more prominent advancements occurred in the period spanning 1930-1980; notably burn resuscitation, early tangential excision, and use of topical antibiotic dressings; and are well documented in burn literature. This article explores the advancements of the past 40 years and the areas of burn management that are presently topics of active discussion and research.
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Affiliation(s)
- Arij El Khatib
- Unité des Grands Brûlés, University of Montreal Medical Centre Sanguinet, 1051, Rue Sanguinet, Montréal, QC H2X 0C1, Canada
| | - Marc G. Jeschke
- Department of Surgery, Division of Plastic Surgery, Department of Immunology, Ross Tilley Burn Centre-Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Rm D704, Toronto, ON M4N 3M5, Canada;
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