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Cancio JM, Dewey WS. Critical Care Rehabilitation of the Burn Patient. Surg Clin North Am 2023; 103:483-494. [PMID: 37149384 DOI: 10.1016/j.suc.2023.01.010] [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
Despite the fact that modern burn care has significantly reduced the mortality associated with severe burn injuries, the rehabilitation and community reintegration of survivors continues to be a challenge. An interprofessional team approach is essential for optimal outcomes. This includes early occupational and physical therapy, beginning in the intensive care unit (ICU). Burn-specific techniques (edema management, wound healing, and contracture prevention) are successfully integrated into the burn ICU. Research demonstrates that early intensive rehabilitation of critically ill burn patients is safe and effective. Further work on the physiologic, functional, and long-term impact of this care is needed.
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Affiliation(s)
- Jill M Cancio
- US Army Institute of Surgical Research, 3698 Chambers Pass Suite B, JBSA Fort Sam Houston, TX 78234-7767, USA.
| | - William S Dewey
- US Army Institute of Surgical Research, 3698 Chambers Pass Suite B, JBSA Fort Sam Houston, TX 78234-7767, USA
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Frear CC, Zang T, Griffin BR, McPhail SM, Parker TJ, Kimble RM, Cuttle L. The modulation of the burn wound environment by negative pressure wound therapy: Insights from the proteome. Wound Repair Regen 2020; 29:288-297. [PMID: 33374033 DOI: 10.1111/wrr.12887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/02/2020] [Indexed: 12/24/2022]
Abstract
Negative pressure wound therapy has been used to promote wound healing in a variety of settings, including as an adjunct to silver-impregnated dressings in the acute management of paediatric burns. Fluid aspirated by the negative pressure wound therapy system represents a potentially insightful research matrix for understanding the burn wound microenvironment and the intervention's biochemical mechanisms of action. The aim of this study was to characterize the proteome of wound fluid collected using negative pressure wound therapy from children with small-area thermal burns. Samples were obtained as part of a randomized controlled trial investigating the clinical efficacy of adjunctive negative pressure wound therapy. They were compared with blister fluid specimens from paediatric burn patients matched according to demographic and injury characteristics. Protein identification and quantification were performed via liquid chromatography tandem mass spectrometry and sequential window acquisition of all theoretical mass spectra data-independent acquisition. Proteins and biological pathways that were unique to or enriched in negative pressure wound therapy fluid samples were evaluated using principal components, partial least squares-discriminant, and gene ontology enrichment analyses. Eight viable samples of negative pressure wound therapy fluid were collected and analyzed with eight matched blister fluid samples. A total of 502 proteins were quantitatively profiled in the negative pressure wound therapy fluid, of which 444 (88.4%) were shared with blister fluid. Several proteins exhibited significant abundance differences between fluid types, with negative pressure wound therapy fluid showing a higher abundance of matrix metalloproteinase-9, arginase-1, low affinity immunoglobulin gamma Fc region receptor III-A, filamin-A, alpha-2-macroglobulin, and hemoglobin subunit alpha. The results lend support to the hypothesis that negative pressure wound therapy augments wound healing through the modulation of factors involved in the inflammatory response, granulation tissue synthesis, and extracellular matrix maintenance. Data are available via ProteomeXchange with identifier PXD023168.
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Affiliation(s)
- Cody C Frear
- Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Tuo Zang
- Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.,Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Bronwyn R Griffin
- Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.,Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Steven M McPhail
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
| | - Tony J Parker
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.,Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Leila Cuttle
- Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.,Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Frear CC, Griffin B, Cuttle L, McPhail SM, Kimble R. Study of negative pressure wound therapy as an adjunct treatment for acute burns in children (SONATA in C): protocol for a randomised controlled trial. Trials 2019; 20:130. [PMID: 30760332 PMCID: PMC6374905 DOI: 10.1186/s13063-019-3223-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 01/28/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although negative pressure wound therapy (NPWT) is widely used in the management of several wound types, its efficacy as a primary therapy for acute burns has not yet been adequately investigated, with research in the paediatric population particularly lacking. There is limited evidence, however, that NPWT might benefit children with burns, amongst whom scar formation, wound progression and pain continue to present major management challenges. The purpose of this trial is to determine whether NPWT in conjunction with standard therapy accelerates healing, reduces wound progression and decreases pain more effectively than standard treatment alone. METHODS/DESIGN A total of 104 children will be recruited for this trial. To be eligible, candidates must be under 17 years of age and present to the participating children's hospital within 7 days of their injury with a thermal burn covering <5% of their total body surface area. Facial and trivial burns will be excluded. Following a randomised controlled parallel design, participants will be allocated to either an active control or intervention group. The former will receive standard therapy consisting of Acticoat™ and Mepitel™. The intervention arm will be treated with silver-impregnated dressings in addition to NPWT via the RENASYS TOUCH™ vacuum pump. Participants' dressings will be changed every 3 to 5 days until their wounds are fully re-epithelialised. Time to re-epithelialisation will be studied as the primary outcome. Secondary outcomes will include pain, pruritus, wound progression, health-care-resource use (and costs), ease of management, treatment satisfaction and adverse events. Wound fluid collected during NPWT will also be analysed to generate a proteomic profile of the burn microenvironment. DISCUSSION The study will be the first randomised controlled trial to explore the clinical effects of NPWT on paediatric burns, with the aim of determining whether the therapy warrants implementation as an adjunct to standard burns management. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12618000256279 . Registered on 16 February 2018.
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Affiliation(s)
- Cody C. Frear
- Centre for Children’s Burns and Trauma Research, Level 7, Children’s Health Research Center, The University of Queensland, 62 Graham St., South Brisbane, QLD 4101 Australia
- The Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Lvl. 5, 501 Stanley St., South Brisbane, QLD 4101 Australia
- The University of Queensland Faculty of Medicine, 288 Herston Rd., Brisbane, QLD 4006 Australia
| | - Bronwyn Griffin
- Centre for Children’s Burns and Trauma Research, Level 7, Children’s Health Research Center, The University of Queensland, 62 Graham St., South Brisbane, QLD 4101 Australia
- The Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Lvl. 5, 501 Stanley St., South Brisbane, QLD 4101 Australia
- The University of Queensland Faculty of Medicine, 288 Herston Rd., Brisbane, QLD 4006 Australia
| | - Leila Cuttle
- Institute of Health and Biomedical Innovation, Centre for Children’s Burns and Trauma Research, Lvl 8, Children’s Health Research Centre, Queensland University of Technology, South Brisbane, QLD 4101 Australia
| | - Steven M. McPhail
- Centre for Functioning and Health Research, Metro South Health, Queensland Health, Brisbane, QLD 4102 Australia
- School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4059 Australia
| | - Roy Kimble
- Centre for Children’s Burns and Trauma Research, Level 7, Children’s Health Research Center, The University of Queensland, 62 Graham St., South Brisbane, QLD 4101 Australia
- The Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Lvl. 5, 501 Stanley St., South Brisbane, QLD 4101 Australia
- The University of Queensland Faculty of Medicine, 288 Herston Rd., Brisbane, QLD 4006 Australia
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Blood and Tissue Silver Levels Following Application of Silver-Based Dressings to Sulfur Mustard Chemical Burns. J Burn Care Res 2018; 38:e818-e823. [PMID: 28846576 DOI: 10.1097/bcr.0000000000000493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Silver-based dressings are commonly used in burn care. Silver sulfadiazine use is associated with elevated blood, urine, and tissue levels of silver ion. We examined wound and tissue levels of silver ion in a two-species model of sulfur mustard chemical burn injury treated with two different silver-based dressings. Superficial dermal and moderate thickness dermal chemical burns were induced in 16 hairless guinea pigs and in 16 Gottingen minipigs by exposure to sulfur mustard vapor. After debridement, silver-nylon burn dressings or silver-calcium alginate dressings were applied and changed every 7 days until wound healing or a maximum of 60 days post exposure. At autopsy, liver, spleen, and wound samples were harvested. Silver ion was measured using inductively coupled plasma-mass spectrography with a lower level of detection of 0.02 parts per billion. Negligible silver ion levels were found in the liver (mean < 0.003 μg/g of tissue) and spleen (mean < 0.05 μg/g) of all 32 animals. Wound biopsies showed silver ion levels ranging from 0.07 to 19.5 μg/g of tissue. Wound levels were higher in minipigs than in hairless guinea pigs and were higher in animals treated with silver-nylon burn wound dressings than with silver-calcium alginate dressings. Silver ion could be detected in some wounds 40 days after dressings were removed. In a chemical burn model, application of silver-nylon or silver-calcium alginate dressings is associated with elevated wound levels but negligible tissue levels of silver ion.
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