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Verdecchia N, Praslick A, Visoiu M. Safety Assessment of Prolonged Nerve Catheters in Pediatric Trauma Patients: A Case Series Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:251. [PMID: 38397363 PMCID: PMC11154573 DOI: 10.3390/children11020251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/05/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Nerve block catheters (NBCs) are increasingly used for pain management in pediatric trauma patients. While short-term efficacy has been well established, the long-term safety of NBCs is unknown. Methods/Cases: The retrospective chart review includes a cohort of nine pediatric trauma patients aged 3-15 years who received 52 peripheral nerve block catheters and epidurals for pain management. This study aimed to investigate the potential risks associated with the prolonged use of NBCs in pediatric trauma cases. RESULTS The NBCs (48 peripheral catheters and 4 epidural catheters) were maintained for about 2 weeks. The number of catheters per patient varied from 1 to 11. The study noted a low frequency of catheter-related complications. No catheter-site infection or local anesthetic toxicity symptoms were reported. DISCUSSION These findings suggest that NBCs can be safely maintained for extended periods in pediatric trauma patients without significantly increasing complications. Careful monitoring and adherence to infection control practices remain paramount when implementing extended catheter use.
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Affiliation(s)
- Nicole Verdecchia
- Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, 4401 Penn Ave., Pittsburgh, PA 15224, USA (M.V.)
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2
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Collins S, Baker EB. Regional anesthesia and POCUS in the intensive care unit. Int Anesthesiol Clin 2024; 62:35-42. [PMID: 38063036 PMCID: PMC11155280 DOI: 10.1097/aia.0000000000000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
This chapter focuses on resident recruitment and recent US National Resident Matching Program changes and the impact in the evaluation and ranking of applicants within the specialty of anesthesiology. Recruitment challenges are examined as well as program strategies and potential future directions. Also discussed are DEI initiatives within the recruitment process.
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Affiliation(s)
- Stephen Collins
- Department of Anesthesiology, University of Virginia Health, Charlottesville, Virginia
| | - E. Brooke Baker
- Division of Regional Anesthesiology and Acute Pain Medicine, Department of Anesthesiology and Critical Care Medicine Chief, Faculty Affairs and DEI, Executive Physician for Claims Management, UNM Hospital System
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Rangraz Jeddi F, Nabovati E, Mobayen M, Akbari H, Feizkhah A, Osuji J, Bagheri Toolaroud P. Health care needs, eHealth literacy, use of mobile phone functionalities, and intention to use it for self-management purposes by informal caregivers of children with burns: a survey study. BMC Med Inform Decis Mak 2023; 23:236. [PMID: 37872538 PMCID: PMC10591411 DOI: 10.1186/s12911-023-02334-w] [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: 12/07/2022] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND This study aimed to assess health care needs, electronic health literacy, mobile phone usage, and intention to use it for self-management purposes by informal caregivers of children with burn injuries. METHODS This cross-sectional research was carried out in 2021 with 112 informal caregivers of children with burns in a burn center in the north of Iran. The data collection tools were questionnaires that included the participants' demographics, their E-Health Literacy, their current mobile phone usage, and their desires for mobile phone use for burn care services. RESULTS Most informal caregivers had smartphones (83.0%) and Internet access (81.3%). Most participants occasionally used phone calls (63.4%), the Internet (45.5%), and social media (42.9) to receive information about psychosocial disorders, infection control, wound care, pain, itch, physical exercise, and feeding. Most participants have never used some of the mobile phone functionalities to receive burn-related information, such as applications/Software (99.1%) and e-mail (99.1%). Nevertheless, most informal caregivers desire to use mobile applications for self-management purposes in the future (88.4%). The mean eHealth literacy score was 25.01 (SD = 9.61). Informal caregivers who had higher education levels, access to the Internet, and lived in urban areas had higher eHealth literacy (P < 001). CONCLUSION The current research delivers beneficial information about the healthcare needs of informal caregivers and their preference to use mobile functionality to receive burns-related healthcare and rehabilitation information post-discharge. This information can help design and implement mobile health (mHealth) interventions to enhance the self-care skills of informal caregivers.
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Affiliation(s)
- Fatemeh Rangraz Jeddi
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran
| | - Ehsan Nabovati
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammadreza Mobayen
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Hossein Akbari
- Social Determinants of Health (SDH) Research Center, Department of Biostatistics and Epidemiology, School of Public Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Alireza Feizkhah
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Department of Medical Physics, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Joseph Osuji
- School of Nursing and Midwifery, Faculty of Health, Community, and Education, Mount Royal University, Calgary, Ab, Canada
| | - Parissa Bagheri Toolaroud
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran.
- Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran.
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4
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Halim N, Holland AJA, McMaugh A, Cameron CM, Lystad RP, Badgery-Parker T, Mitchell R. Impact of childhood burns on academic performance: a matched population-based cohort study. Arch Dis Child 2023; 108:808-814. [PMID: 37423641 PMCID: PMC10511986 DOI: 10.1136/archdischild-2023-325769] [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: 04/29/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE This study aimed to compare academic performance and high school completion of young people hospitalised for a burn compared with young people not hospitalised for an injury. DESIGN A retrospective population-based matched case-comparison cohort study. PARTICIPANTS Young people aged ≤18 years hospitalised for a burn during 2005-2018 in New South Wales, Australia, with age, sex and residential postcode-matched peers not hospitalised for any injury during 1 July 2001 and 31 December 2018. MAIN OUTCOME MEASURES Performance below the national minimum standard (NMS) on the National Assessment Plan for Literacy and Numeracy assessments and not completing high school. RESULTS Young females hospitalised for a burn had a 72% higher risk of poorer reading compared with their peers (adjusted relative risk (ARR) 1.72; 95% CI 1.33 to 2.23), while young males hospitalised with a burn showed no higher risk (ARR 1.14; 95% CI 0.91 to 1.43). Young males (ARR 1.05; 95% CI 0.81 to 1.35) and females (ARR 1.34; 95% CI 0.93 to 1.94) hospitalised with a burn had no higher risk of not reaching the NMS for numeracy compared with peers. Young people hospitalised with a burn had at least twice the risk of not completing year 10 (ARR 3.86; 95% CI 1.68 to 8.86), year 11 (ARR 2.45; 95% CI 1.89 to 3.18) and year 12 (ARR 2.09; 95% CI 1.63 to 2.67) compared with matched counterparts. CONCLUSIONS Young females hospitalised with a burn displayed poorer academic performance for reading compared with matched peers, while males and females were more likely to leave school earlier. Identifying unmet learning support needs of young burn survivors should be investigated.
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Affiliation(s)
- Nicole Halim
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Andrew J A Holland
- Department of Pediatric Surgery, Children's Hospital Westmead, Westmead, New South Wales, Australia
| | - Anne McMaugh
- The Macquarie School of Education, Macquarie University, Sydney, New South Wales, Australia
| | - Cate M Cameron
- Jamieson Trauma Institute, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Tim Badgery-Parker
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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5
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Blokzijl SJ, Lamberts KF, Nieuwenhuis MK, Beerthuizen GIJM, Spikman JM. Virtual Reality as Pain Relief in Burn Care: A Pilot Randomized Controlled Trial on the Effectiveness on Pain During Multiple Dressing Changes. J Burn Care Res 2023; 44:1125-1133. [PMID: 36929448 DOI: 10.1093/jbcr/irad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Indexed: 03/18/2023]
Abstract
This pilot Randomized Controlled Trial (RCT) aimed to investigate the effectiveness of Virtual Reality (VR)-distraction on pain during multiple Wound Dressing Changes (WDCs). Furthermore, associations between demographic, clinical, and psychological factors and pain during WDC were determined. Participants were randomized to either the VR-condition or Care As Usual (CAU)-condition. Both groups received standard wound care and pain medication. The VR-group additionally received VR-distraction. The primary outcome measure was pain intensity (VAT 0-10). Secondary outcome measures were pain medication (Fentanyl spray and/or Piritramide) and satisfaction with WDC (VAT 0-10). Only 38 patients (VR-group: n = 21; CAU-group: n = 17) of the 128 intended patients were included during the study period due to several limitations (strict exclusion criteria and restrictions of the VR-equipment). No significant differences were found between both groups on pain intensity and medication. Both groups were also equally satisfied with WDC. Age showed a significant negative correlation with pain during WDC. In view of the small sample size, this study has restricted power and should be considered a pilot. Nevertheless, a RCT with between-subjects design across multiple WDCs was feasible and, given the speed of VR-developments, we expect larger, better powered RCTs to be possible in the near future, for which our experiences and recommendations are relevant.
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Affiliation(s)
- Susanne J Blokzijl
- Department of Medical Psychology, Martini Hospital, Groningen, The Netherlands
| | | | - Marianne K Nieuwenhuis
- Association of Dutch Burn Centres, Burn Centre Martini Hospital, Groningen, The Netherlands
| | | | - Jacoba M Spikman
- Department of Neurology, University Medical Centre Groningen (UMCG), University of Groningen, The Netherlands
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6
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Farzan R, Parvizi A, Haddadi S, Sadeh Tabarian M, Jamshidbeigi A, Samidoust P, Ghorbani Vajargah P, Mollaei A, Takasi P, Karkhah S, Firooz M, Hosseini SJ. Effects of non-pharmacological interventions on pain intensity of children with burns: A systematic review and meta-analysis. Int Wound J 2023; 20:2898-2913. [PMID: 36859758 PMCID: PMC10410361 DOI: 10.1111/iwj.14134] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/03/2023] Open
Abstract
Pain is one of the complications associated with burns, which can lead to anxiety and sleeplessness in children. Various studies evaluated the effects of non-pharmacological interventions on burn wound care. The present study was conducted to determine the effects of non-pharmacological interventions on pain intensity of children with burns. A comprehensive systematic search was conducted in various international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as 'Non-pharmacological', 'Virtual reality', 'Pain', 'Burn', 'Wound' and 'Child' from the earliest to December 1, 2022. The risk of bias in the final articles was also assessed with the Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). Finally, a total of 1005 burn patients were included in 19 studies. The age range of the patients was from 0.5 to 19 years. Of the participants, 50.05% were in the intervention group. All studies had a randomised clinical trial design. The results found that non-pharmacological interventions significantly reduced pain intensity in children (ES: -0.73, 95% CI: -1.08 to -0.38, Z = 4.09, I2 :79.8, P < .001). Virtual reality (VR) (ES: -0.54, 95% CI: -1.19 to -0.18, Z = 2.90, I2 :72.9%, P = .004) and non-VR (ES: -0.86, 95% CI: -1.45 to -0.27, Z = 2.86, I2 :91.4%, P = .04) interventions decreased pain intensity significantly in children based sub-group analysis. Non-pharmacological interventions significantly reduced the pain intensity of dressing removal (ES: -0.77, 95% CI: -1.34 to -0.20, Z = 66.3, I2 :91.8%, P = .008), dressing application (ES: -0.53, 95% CI: -0.97 to -0.09, Z = 2.37, I2 :60.8%, P = .02), and physical therapy (ES: -1.18, 95% CI: -2.10 to -0.26, Z = 2.51, I2 :88.0%, P = .01). Also, interventions reduced the pain of burn wound care (ES: -0.29, 95% CI: -1.01 to 0.44, Z = 0.78, I2 :72.6%, P = .43), but it was statistically insignificant. In sum, the result of the present study indicated that using non-pharmacological interventions significantly reduced pain intensity in children. The reduction of pain intensity was greater in non-VR than in VR interventions. Future studies should focus on comparing VR interventions with non-VR and single versus multi-modal distraction to clarify the effectiveness of each.
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Affiliation(s)
- Ramyar Farzan
- Department of Plastic & Reconstructive SurgerySchool of Medicine, Guilan University of Medical SciencesRashtIran
| | - Arman Parvizi
- Anesthesiology Research Center, Department of AnesthesiologyAlzahra Hospital, Guilan University of Medical SciencesRashtIran
| | - Soudabeh Haddadi
- Anesthesiology Research Center, Department of AnesthesiologyAlzahra Hospital, Guilan University of Medical SciencesRashtIran
| | - Mansooreh Sadeh Tabarian
- Department of Medical‐Surgical NursingNorth Khorasan University of Medical SciencesNorth KhorasanIran
| | - Amirreza Jamshidbeigi
- Student Research Committee, Faculty of Nursing and MidwiferyMashhad University of Medical SciencesMashhadIran
| | - Pirouz Samidoust
- Razi Clinical Research Development UnitRazi Hospital, Guilan University of Medical SciencesRashtIran
| | - Pooyan Ghorbani Vajargah
- Department of Medical‐Surgical NursingSchool of Nursing and Midwifery, Guilan University of Medical SciencesRashtIran
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Amirabbas Mollaei
- Department of Medical‐Surgical NursingSchool of Nursing and Midwifery, Guilan University of Medical SciencesRashtIran
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Poorya Takasi
- Department of Medical‐Surgical NursingSchool of Nursing and Midwifery, Guilan University of Medical SciencesRashtIran
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Samad Karkhah
- Department of Medical‐Surgical NursingSchool of Nursing and Midwifery, Guilan University of Medical SciencesRashtIran
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Mahbobeh Firooz
- Department of NursingEsfarayen Faculty of Medical SciencesEsfarayenIran
- School of Nursing and MidwiferyGolestan University of Medical SciencesGorganIran
| | - Seyed Javad Hosseini
- Department of NursingEsfarayen Faculty of Medical SciencesEsfarayenIran
- Department of Pediatric NursingSchool of Nursing and Midwifery, Mashhad University of Medical SciencesMashhadIran
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Cohen N, Cohen DM, Barbi E, Shavit I. Analgesia and Sedation of Pediatric Patients with Major Trauma in Pre-Hospital and Emergency Department Settings-A Narrative Review. J Clin Med 2023; 12:5260. [PMID: 37629302 PMCID: PMC10455791 DOI: 10.3390/jcm12165260] [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: 06/20/2023] [Revised: 07/18/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Children who sustain major injuries are at risk of receiving insufficient pain relief and sedation, which can have physical and psychological repercussions. Heightened emotional distress can increase the likelihood of developing symptoms of post-traumatic stress. Providing sufficient analgesia and sedation for children with major trauma presents specific challenges, given the potential for drug-related adverse events, particularly in non-intubated patients. The current literature suggests that a relatively low percentage of pediatric patients receive adequate analgesia in pre-hospital and emergency department settings following major trauma. There are only sparse data on the safety of the provision of analgesia and sedation in children with major trauma in the pre-hospital and ED settings. The few studies that examined sedation protocols in this context highlight the importance of physician training and competency in managing pediatric airways. There is a pressing need for prospective studies that focus upon pediatric major trauma in the pre-hospital and emergency department setting to evaluate the benefits and risks of administering analgesia and sedation to these patients. The aim of this narrative review was to offer an updated overview of analgesia and sedation management in children with major trauma in pre-hospital and ED settings.
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Affiliation(s)
- Neta Cohen
- Pediatric Emergency Medicine Department, Dana Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv 6423906, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Daniel M. Cohen
- Nationwide Children’s Hospital, The Ohio State University, Columbus, OH 43210, USA;
| | - Egidio Barbi
- Department of Pediatrics, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy;
- Clinical Department of Medical Surgical and Health Science, University of Trieste, 34127 Trieste, Italy
| | - Itai Shavit
- Division of Pediatrics, Hadassah Medical Center, Jerusalem 9112001, Israel;
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
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Yao PY, Shaw SJ, Gabriel RA, Soria CS. Does caudal analgesia improve pain control for pediatric burn surgery: A retrospective study. PAEDIATRIC & NEONATAL PAIN 2023; 5:10-15. [PMID: 36911788 PMCID: PMC9997120 DOI: 10.1002/pne2.12091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/14/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
Pediatric burns affect approximately 15-20 patients per 100 000 hospital admissions, but unfortunately there is a lack of evidence to guide optimal strategies for acute pain control. The aim of this study was to evaluate whether caudal analgesia with single injection of local anesthetics reduced pain medication consumption in pediatric patients who required surgical intervention for burn injuries. Retrospective data from patients <7 years old who had burn surgery in the operating rooms at a single regional burn center from 2013 to 2021 was obtained and analyzed. A 1:1 propensity-score matching method using nearest neighbor matching without replacement was utilized to create matched cohorts. Primary outcome was opioid consumption, which is presented as opioid equivalents divided by patient weight in kilograms, at 24 h after surgery. Comparing propensity-score matched groups, there were no statistically significant differences in adjusted morphine equivalents received by the caudal group (0.122 [0.0646;0.186]) and the no caudal group (0.0783 [0.0384;0.153]) at 24 h after surgery (p = 0.06). This is the first study to the best of our knowledge of the association of caudal analgesia in pediatric burn patients with postoperative pain control. The data showed an increase in pain medication consumption postoperative at 24 h and intraoperative for patients who received single injection caudal blocks, but when adjusted using propensity-score matching, the difference was no longer statistically significant.
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Affiliation(s)
- Phil Y Yao
- Department of Anesthesiology University of California San Diego San Diego California USA
| | - Susanna J Shaw
- Department of Anesthesiology University of California San Diego San Diego California USA
| | - Rodney A Gabriel
- Department of Anesthesiology University of California San Diego San Diego California USA
| | - Claire S Soria
- Department of Anesthesiology University of California San Diego San Diego California USA
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The Emerging Role of Virtual Reality as an Adjunct to Procedural Sedation and Anesthesia: A Narrative Review. J Clin Med 2023; 12:jcm12030843. [PMID: 36769490 PMCID: PMC9917582 DOI: 10.3390/jcm12030843] [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: 12/19/2022] [Revised: 01/03/2023] [Accepted: 01/08/2023] [Indexed: 01/24/2023] Open
Abstract
Over the past 20 years, there has been a significant reduction in the incidence of adverse events associated with sedation outside of the operating room. Non-pharmacologic techniques are increasingly being used as peri-operative adjuncts to facilitate and promote anxiolysis, analgesia and sedation, and to reduce adverse events. This narrative review will briefly explore the emerging role of immersive reality in the peri-procedural care of surgical patients. Immersive virtual reality (VR) is intended to distract patients with the illusion of "being present" inside the computer-generated world, drawing attention away from their anxiety, pain, and discomfort. VR has been described for a variety of procedures that include colonoscopies, venipuncture, dental procedures, and burn wound care. As VR technology develops and the production costs decrease, the role and application of VR in clinical practice will expand. It is important for medical professionals to understand that VR is now available for prime-time use and to be aware of the growing body in the literature that supports VR.
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10
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Muacevic A, Adler JR. Pediatric First-Degree Burn Management With Honey and 1% Silver Sulfadiazine (Ag-SD): Comparison and Contrast. Cureus 2022; 14:e32842. [PMID: 36570107 PMCID: PMC9779910 DOI: 10.7759/cureus.32842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background The cardinal area of managing fire wounds is guided by adequately evaluating the burn-induced lesion's profundity and size. Superficial second-degree burns are often treated through daily reinstating with fresh sterile bandaging with appropriate topical antimicrobials to allow rapid spontaneous epithelialization. Around the world, a wide variety of substances are used to treat these wounds, from honey to synthetic biological dressings. Objective This study intended to determine honey's therapeutic potential compared with 1% silver sulfadiazine (Ag-SD) in arsenal-caused contusion medicament fulfillment. Methods A total of 70 cases were evaluated in this research work after fulfilling the required selection criteria during the study period of January 2014 to December 2014 and January 2017 to December 2017. Purposive selection criteria were adopted in the study to select research patients. The patients in Group-1 (n = 35) relied on honey as medication, while patients in Group-2 (n = 35) relied on 1% Ag-SD. Results In Group-1, exudation (68.4%) and sloughing (82.9%) were substantially reduced by Days 3 and 5 of therapeutic intervention, respectively. However, in Group-2, a reduction of exudation (17.1%) and sloughing (22.9%) occurred after Days 3 and 5 of treatment, respectively. Completion of the epithelialization process was observed among Group-1 and Group-2 cases. It was detected after Days 7 and 10 of treatment at 36.3% and 77% (Group-1) and 27% and 67% (Group-2), respectively. Around 3 ml of 1% honey was required per body surface area per dressing in Group-1. On the other hand, in Group-2, 2 gm Ag-SD was needed per body surface area per dressing. Conclusion Patients treated with honey found better clinical outcomes in managing superficial partial-thickness burns.
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11
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Sadeq F, DePamphilis MA, Dabek RJ, Bojovic B, Fuzaylov G, Driscoll DN. Evaluation of liposomal bupivacaine infiltration at reconstructive skin graft donor sites in adolescent and young adult burn patients: A retrospective analysis. Burns 2022; 48:1166-1171. [PMID: 34862091 DOI: 10.1016/j.burns.2021.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/12/2021] [Accepted: 08/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Postoperative pain at skin graft donor sites is frequently undertreated in burn patients, which can impair reconstructive outcomes and result in harmful psychological consequences. We find a critical need to explore and promote non-opioid, multimodal analgesics. Donor site infiltration of the local anesthetic liposomal bupivacaine in adolescent and young adult burn patients has not been previously investigated. Therefore, the goal of this study was to evaluate intraoperative liposomal bupivacaine infiltration for postoperative donor site pain control in adolescent and young adult burn patients undergoing reconstructive skin graft procedures. METHODS This retrospective analysis included patients aged 14-25 years, who underwent at least two reconstructive skin graft procedures, one that received donor site infiltration of the standard treatment (bupivacaine hydrochloride) and one that received donor site infiltration of liposomal bupivacaine. The final sample included 30 patients with a total of 44 liposomal bupivacaine cases and 53 standard treatment cases analyzed. RESULTS In the authors' five-year experience, the use of liposomal bupivacaine compared to standard treatment was associated with statistically significant decreases in 0-4 h postoperative pain scores (mean 1.4/10 versus 2.3/10, p = 0.04) and 0-24 h postoperative pain scores (mean 1.7/10 versus 2.4/10, p = 0.02). Neither analgesic was associated with adverse events. Differences in length of stay and inpatient postoperative opioid usage were not regarded as significant. CONCLUSION In this retrospective analysis, the authors report the first results that suggest intraoperative liposomal bupivacaine donor site infiltration may be associated with statistically improved patient outcomes in adolescent and young adult burn patients. However, the reported differences are most likely not clinically significant, establishing the necessity for further evaluation of using liposomal bupivacaine in this unique patient population.
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Affiliation(s)
- Farzin Sadeq
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States
| | - Matthew A DePamphilis
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Boston University School of Medicine, Boston, MA, United States
| | - Robert J Dabek
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, St. Agnes Hospital, Baltimore, MD, United States
| | - Branko Bojovic
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children - Boston, Boston, MA, United States
| | - Gennadiy Fuzaylov
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA, United States
| | - Daniel N Driscoll
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children - Boston, Boston, MA, United States.
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12
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Adjunctive Nonpharmacologic Interventions for the Management of Burn Pain: A Systematic Review. Plast Reconstr Surg 2022; 149:985e-994e. [PMID: 35311762 DOI: 10.1097/prs.0000000000009059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The conventional way of treating burn victims with mainstream pain control modalities is costly and has many negative side effects. In this study, the authors aim to present the findings from the major clinical trials on three nonpharmacologic interventions-hypnosis, virtual/augmented reality, and yoga-as supplements to conventional pain regimens for burn management. METHODS A computerized literature search was conducted of the PubMed and ClinicalTrials.gov databases in April of 2020. The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. RESULTS The search yielded 254 articles from 1955 to 2020. Fifty-eight studies met the authors' inclusion criteria. Yoga reduced cognitive and somatic anxiety in burn survivors, and improved body image. Virtual reality is effective in pain reduction in both the pediatric and the adult burn population, and in faster burn wound reepithelialization. Hypnosis has similar results regarding reducing pain quality and anxiety in burn patients undergoing burn wound care and dressing changes but was not found to significantly accelerate the healing process. CONCLUSIONS Nonpharmacologic interventions are not a substitute for conventional analgesics; however, they could help patients have better control over their pain, greater self-esteem, and less postburn traumatic experiences. Burn care centers should consider nonpharmacologic interventions to improve patient satisfaction and their participation in the treatment and rehabilitation process.
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13
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Cuttle L, Fear M, Wood FM, Kimble RM, Holland AJA. Management of non-severe burn wounds in children and adolescents: optimising outcomes through all stages of the patient journey. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:269-278. [PMID: 35051408 DOI: 10.1016/s2352-4642(21)00350-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/11/2022]
Abstract
Paediatric burn injuries are common, especially in children younger than 5 years, and can lead to poor physical and psychosocial outcomes in the long term. In this Review, we aim to summarise the key factors and interventions before hospital admission and following discharge that can improve the long-term outcomes of paediatric burns. Care can be optimised through first aid treatment, correct initial assessment of burn severity, and appropriate patient referral to a burns centre. Scar prevention or treatment and patient follow-up after discharge are also essential. As most burn injuries in children are comparatively small and readily survivable, this Review does not cover the perioperative management associated with severe burns that require fluid resuscitation, or inhalational injury. Burns disproportionately affect children from low socioeconomic backgrounds and those living in low-income and middle-income countries, with ample evidence to suggest that there remains scope for low-cost interventions to improve care for those patients with the greatest burden of burn injury. Current knowledge gaps and future research directions are discussed.
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Affiliation(s)
- Leila Cuttle
- Centre for Children's Health Research, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Mark Fear
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia; Burns Service of Western Australia, Perth Children's Hospital and Fiona Stanley Hospital, Perth, WA, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, The University of Queensland, South Brisbane, QLD, Australia; Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Andrew J A Holland
- The Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, The University of Sydney, NSW, Westmead, Australia
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14
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Carlson A, Pham D, Price C, Reisch J, Iskander I, Ambardekar A. Novel use of methadone intraoperatively in pediatric burn patients. J Burn Care Res 2022; 43:1294-1298. [PMID: 35245371 DOI: 10.1093/jbcr/irac022] [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
Burn injury in children can cause severe and chronic physical and mental sequelae. Opioids are a mainstay in burn pain management but increasing utilization in this country has led to concern for their continued use and potential for dependence. Methadone is a long-acting analgesic that targets the N-methyl-D-aspartate (NMDA) receptor in addition to the mu opioid receptor and has benefit in adult burn patients. However, its use in the pediatric burn population has been less robustly studied. This is a retrospective cohort study at a single Level 1 Burn Center whose primary aim is to compare opioid utilization 36 hours postoperatively between pediatric burn patients who received intraoperative, intravenous methadone and those who did not. Secondary aim was to describe differences in methadone-related complications between the cohorts. There was decreased opioid utilization measured by median morphine equivalents per kilogram (ME/kg) postoperatively in the methadone cohort compared to the control cohort (0.54mg/kg v. 0.77mg/kg, p = 0.18). No adverse events were noted upon chart review. The data suggests methadone use is beneficial in pediatric burn patients, but further prospective studies are warranted on a larger population.
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Affiliation(s)
| | - David Pham
- UT Southwestern Medical Center, Dallas, TX
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15
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Tran Thi TH, Konara Mudiyanselage SP, Huang MC. Effects of Distraction on Reducing Pain During Invasive Procedures in Children with Cancer: A Systematic Review and Meta-Analysis. Pain Manag Nurs 2022; 23:281-292. [PMID: 35031216 DOI: 10.1016/j.pmn.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 11/24/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Distraction is a known behavioral intervention that is widely used for pain management in the pediatric population. However, there is a shortage of reviews reporting the efficacy of distraction for procedural pain reduction in pediatric oncology settings. AIM To determine the current evidence on the effects of distraction on procedural pain in children with cancer. DESIGN This systematic review and meta-analysis was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines SETTINGS: Six different databases from 1990 to June 2019. METHOD A literature search was conducted to identify the effects of distraction on procedural pain reduction in children with cancer. A meta-analysis was undertaken along with applying a mixed effect model to quantify the standardized mean difference in the 95% confidence interval (CI) as the overall effects. RESULTS Ten randomized controlled trials were included. Distraction during an invasive procedure had a large effect on pain intensity (-0.92, 95% CI -1.48 to -0.36, p = .001) and on needle insertion as well (-1.12, 95% CI -1.52 to -0.72, p = .000), but only a moderate effect on lumbar puncture procedures (-0.57, 95% CI -1.02 to -0.12, p = .012). Uncertain effects on pain relief showed up in a virtual reality (VR) distraction (-0.93, 95% CI -2.63 to 0.76, p = .28) and during active distraction (-0.72, 95% CI -1.48 to 0.03, p = .06). CONCLUSIONS Distraction is an efficacious intervention to reduce procedural pain during needle insertion or lumbar puncture procedures in children with cancer. However, the efficacy of active distraction and VR remain uncertain. Future research should focus on specific comparisons of different forms of distractions with larger sample sizes.
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Affiliation(s)
- Thu Hang Tran Thi
- Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan; Department of Nursing and Medical Technology, Pham Ngoc Thach University of Medicine, Vietnam
| | | | - Mei-Chih Huang
- Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan; Deaprtment of Nursing, National Tainan Junior College of Nursing, Taiwan.
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16
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Kheradmand M, Shoghi M, Zand Aghtaii M. The effect of the active and passive distraction techniques on the burn children's pain intensity and anxiety during dressing changes. JOURNAL OF NURSING AND MIDWIFERY SCIENCES 2022. [DOI: 10.4103/jnms.jnms_139_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Richman M, Berman JM, Ross EM. Regional Anesthesia Use in Pediatric Burn Surgery: A Descriptive Retrospective Series. Cureus 2021; 13:e19063. [PMID: 34853768 PMCID: PMC8608680 DOI: 10.7759/cureus.19063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 11/30/2022] Open
Abstract
Pediatric burns are a common and often devastating injury. Treatment, reconstruction, and rehabilitation are painful experiences. For some, the experience triggers post-traumatic stress disorder and/or a chronic pain syndrome. Given the role pain plays as a major secondary disease, it must be addressed to achieve optimal healing. Regional anesthesia has been used extensively to manage postoperative pain and reduce the need for opioids following other surgical procedures in children. However, regional anesthesia is not widely used in pediatric burn care. We present a descriptive, retrospective case series of 15 pediatric burn patients who received regional anesthesia as part of their intra-operative pain management. In our patient population, we saw low levels of anesthetic as well as opioid usage with well-controlled pain. In this cohort, 93% of patients scored a 0/10 on the Face, Legs, Activity, Cry and Consolability (FLACC) scale for pain by post-anesthesia care unit (PACU) discharge, with an average PACU stay of 70 minutes. Thirty-three percent of patients received no opioids, with the average opioid dose being 0.06mg/kg morphine equivalents. This case series serves to make clinicians aware of the feasibility of use and benefits of regional anesthesia in pediatric burn patients requiring operative repair.
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Affiliation(s)
- Michael Richman
- Department of Pediatric Anesthesiology, Seattle Children's Hospital, Seattle, USA
| | - Jeffrey M Berman
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Elizabeth M Ross
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, USA
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18
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Luca-Pozner V, Nischwitz SP, Conti E, Lipa G, Ghezal S, Luze H, Funk M, Remy H, Qassemyar Q. The use of a novel burn dressing out of bacterial nanocellulose compared to the French standard of care in paediatric 2nd degree burns - A retrospective analysis. Burns 2021; 48:1472-1480. [PMID: 34924226 DOI: 10.1016/j.burns.2021.11.019] [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] [Received: 07/21/2021] [Revised: 08/18/2021] [Accepted: 11/23/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE Paediatric burn care is a delicate discipline which benefits from special attention. Despite being highly effective, the current standard of care for second degree burns in the largest paediatric burn center in France - exposure to infrared light - involves long hospital stays, straining economic and professional resources, especially in times of a pandemic. The present study investigated this standard of care and compared it to the use of a bacterial nanocellulose dressing. MATERIALS AND METHODS A retrospective analysis of two groups has been performed: the control group assessed thirty consecutive children treated with the standard of care, and the intervention group assessed thirty consecutive children treated with the bacterial nanocellulose dressing. Parameters evaluated were: healed wounds, additional treatments, rate of infections, hospital length of stay, pain experience and overall satisfaction. RESULTS The two groups did not differ significantly in terms of age and TBSA. A significant reduction in hospital length of stay (p < .001) and pain experience (p < .001) could be observed. In terms of healed wounds, additional treatments and infections, the two groups were equally matched (p > .05) with satisfactory results in both groups. Tendencies towards better results could be seen in the intervention group. CONCLUSION The use of bacterial nanocellulose wound dressings is an important tool in the armamentarium of today's burn surgeons. Satisfying results were achieved, ameliorating burn care for children. Future studies are indicated to further support its value and assess the economic impact.
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Affiliation(s)
- V Luca-Pozner
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France; Sorbonne University, 91-105 Boulevard de l'Hopital, Paris, France
| | - S P Nischwitz
- COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
| | - E Conti
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France
| | - G Lipa
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France
| | - S Ghezal
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France
| | - H Luze
- COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - M Funk
- EVOMEDIS GmbH, Graz, Austria
| | - H Remy
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France
| | - Q Qassemyar
- Armand Trousseau Hospital, Department of Plastic and Reconstructive Surgery, 28 Av du Dr Arnold Netter, Paris, France; Sorbonne University, 91-105 Boulevard de l'Hopital, Paris, France
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19
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Shahi N, Meier M, Phillips R, Shirek G, Goldsmith A, Recicar J, Zuk J, Bielsky A, Yaster M, Moulton S. Pain Management for Pediatric Burns in the Outpatient Setting: A Changing Paradigm? J Burn Care Res 2021; 41:814-819. [PMID: 32303748 DOI: 10.1093/jbcr/iraa049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Childhood burns are common and distressing for children and their parents. Pain is the most common complaint and often thought to be undertreated, which can negatively influence the child's care and increase the risk of posttraumatic stress disorder. There is limited literature on the role of opioids and multimodal therapy in the treatment of pediatric outpatient burns. We sought to evaluate the current use of opioids (including the use of multimodal therapies), storage, and disposal of opioids in this patient population. Parents of burn-injured children 8 months to 18 years old, who were seen in an outpatient setting within 2 weeks of their burn injury, were queried from April to December 2019 regarding their child's pain control, opioid medication use, over-the-counter pain medication use, opioid storage, and disposal. A total of 142 parents of burn-injured children and their parents were surveyed. The median age of the burn-injured children was 2.7 years old and the majority (54.2%; 77/142) were male. The mean total body surface area (TBSA) was 1.8% and half sustained burn injuries to one or both hands. The most frequently used regimens for constant and/or breakthrough pain control were acetaminophen (62.7%) and nonsteroidal anti-inflammatory drugs (NSAIDs; 68.3%). Less than one fifth (26/142;18%) of patients were prescribed opioids and 88% filled their prescription. The median number of doses of opioids prescribed was eight doses, with a median of four doses of opioids unused. Only three patients used all of their prescribed opioids and no patient ≥12 years old used their entire prescription. Burns greater than 3% TBSA, irrespective of burn injury location, were associated with opioid prescription (P = .003). Approximately 40% (10/26) of parents who filled their child's opioid prescription stored the opioid in a locked area. Fewer than one third (7/26) of patients were educated on how to dispose of excess opioid pain medication. Overall, most pediatric outpatient burn injuries can be successfully managed with over-the-counter medications. Providers, who care for burn-injured children ≤ 12 years old with burns that cover ≥3% TBSA in the outpatient setting, should consider no more than four opioid doses for initial pain control. This guideline, coupled with family and provider-centered education on multimodal therapy at the time of initial presentation and safe use of opioids, are important first steps to minimizing the use of opioids in the management of small area burns in children.
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Affiliation(s)
- Niti Shahi
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado.,University of Colorado School of Medicine, Aurora, Colorado
| | - Maxene Meier
- The Center for Research in Outcomes for Children's Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Ryan Phillips
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado.,University of Colorado School of Medicine, Aurora, Colorado
| | - Gabrielle Shirek
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado
| | - Adam Goldsmith
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado
| | - John Recicar
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado
| | - Jeannie Zuk
- University of Colorado School of Medicine, Aurora, Colorado
| | - Alan Bielsky
- University of Colorado School of Medicine, Aurora, Colorado.,Department of Anesthesia, Children's Hospital Colorado, Aurora, Colorado
| | - Myron Yaster
- University of Colorado School of Medicine, Aurora, Colorado.,Department of Anesthesia, Children's Hospital Colorado, Aurora, Colorado
| | - Steven Moulton
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado.,University of Colorado School of Medicine, Aurora, Colorado
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20
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Pain Management in Pediatric Trauma. CURRENT TRAUMA REPORTS 2021. [DOI: 10.1007/s40719-021-00216-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Gillum M, Huang S, Kuromaru Y, Dang J, Yenikomshian HA, Gillenwater TJ. Nonpharmacologic Management of Procedural Pain in Pediatric Burn Patients: A Systematic Review of Randomized Controlled Trials. J Burn Care Res 2021; 43:368-373. [PMID: 34534314 DOI: 10.1093/jbcr/irab167] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pain following burn injury is associated with long-term health consequences in the pediatric population. Literature suggests nonpharmacologic treatment may provide improved pain control as an effective adjunct for these patients. This study aims to summarize randomized controlled trials on nonpharmacologic procedural pain management in pediatric burn patients. A systematic review was conducted on nonpharmacologic procedural pain management techniques used in the pediatric burn population. Fifteen studies were included and involved virtual reality, distraction devices, child life therapy, directed play, digital tablet games, cartoons, hypnosis, and music therapy. Treatment was effective in 8 out of 15 studies. Compared to controls, nonpharmacologic treatments reduced mid procedure pain by 19.7% and post procedure pain by 20.1%. This study demonstrates nonpharmacologic therapy can be an effective adjunct in pediatric procedural burn pain management, however further studies are needed to develop standardized algorithms to integrate nonpharmacologic treatments with pharmacologic therapies.
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Affiliation(s)
- Matthew Gillum
- Keck School of Medicine, University of Southern California, Los Angeles CA.,Los Angeles County Regional Burn Center, Los Angeles County + University of Southern California Medical Center
| | - Samantha Huang
- Keck School of Medicine, University of Southern California, Los Angeles CA.,Los Angeles County Regional Burn Center, Los Angeles County + University of Southern California Medical Center
| | - Yuki Kuromaru
- Keck School of Medicine, University of Southern California, Los Angeles CA.,Los Angeles County Regional Burn Center, Los Angeles County + University of Southern California Medical Center
| | - Justin Dang
- Los Angeles County Regional Burn Center, Los Angeles County + University of Southern California Medical Center
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles CA.,Los Angeles County Regional Burn Center, Los Angeles County + University of Southern California Medical Center
| | - T Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles CA.,Los Angeles County Regional Burn Center, Los Angeles County + University of Southern California Medical Center
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22
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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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23
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Ardahan Akgül E, Karakul A, Altın A, Doğan P, Hoşgör M, Oral A. Effectiveness of lavender inhalation aromatherapy on pain level and vital signs in children with burns: a randomized controlled trial. Complement Ther Med 2021; 60:102758. [PMID: 34229085 DOI: 10.1016/j.ctim.2021.102758] [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: 07/01/2020] [Revised: 05/07/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Burns are a source of pain, which cannot be fully treated with medications. OBJECTIVES This study aims is to test the effectiveness of lavender oil inhalation aromatherapy applied before dressing change on vital signs and pain levels of children with burns. DESIGN This randomized controlled study was held between May 2018 and May 2019. A total of 108 children who met the inclusion criteria were studied in three groups: Lavender-15 Group inhaled lavender oil for 15 min before dressing (n:36), Lavender-60 Group inhaled lavender oil for 60 min before dressing (n:36), and Control Group inhaled jojoba (placebo) oil for 15 min before dressing (n:36). Baseline pain levels and vital signs of the children were measured before inhalation. Pain levels and vital signs of the children were re-measured at the 1st and 30th minutes after dressing. RESULTS There was no significant difference between the groups in terms of pain levels (p = 0.750) and vital signs before dressing. In post-dressing measurements, the number of respiration (after 1 min p = 0.000, after 30 min p = 0.000), heart rate (after 1 min p = 0.000, after 30 min p = 0.000), mean arterial blood pressure (after 1 min p = 0.010, after 30 min p = 0.000) and pain levels (after 1 min p = 0.000, after 30 min p = 0.000) were lower in the Lavender groups compared to the placebo group. DISCUSSION The result of this research reveals that inhalation aromatherapy which applied before dressing in children with burns affects the reduction of pain levels and stabilization of vital signs.
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Affiliation(s)
- Esra Ardahan Akgül
- İzmir Kâtip Çelebi University, Faculty of Health Sciences, Department of Pediatric Nursing, İzmir, Turkey.
| | - Atiye Karakul
- Tarsus University, Faculty of Health Sciences, Department of Nursing, Mersin, Turkey.
| | - Asiye Altın
- Dr. Behçet Uz Children's Education and Research Hospital, Pediatric Burn Unit, İzmir, Turkey.
| | - Pınar Doğan
- İzmir Kâtip Çelebi University, Faculty of Health Sciences, Department of Pediatric Nursing, İzmir, Turkey.
| | - Münevver Hoşgör
- Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatric Surgery, İzmir, Turkey.
| | - Akgün Oral
- Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatric Surgery, İzmir, Turkey.
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24
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Demir S, Oztorun CI, Erturk A, Guney D, Ertoy A, Doruk H, Tanriverdi F, Azili MN, Senel E. Approaches of Emergency Department Physicians to Pediatric Burns: A Survey Assessment. J Burn Care Res 2021; 43:115-120. [PMID: 34132812 DOI: 10.1093/jbcr/irab087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Burned children generally arrive at emergency departments before referring to specialized burn centers. Their initial treatments are performed by non-burn doctors who work in emergency departments. The aim of this study was to evaluate emergency department doctors' knowledge regarding the initial interventions and transfer of pediatric burn patients. There were 196 participants who completed the survey: 59 were emergency medicine specialists, 46 were general practitioners, and 91 were emergency medicine residents. Sixty-five stated that they always calculate the burn surface areas, and 144 stated that the Parkland formula should be used to calculate the fluid requirements for the first 24 hours. Of all participants, only 21 marked the correct choice as the Lund-Browder scheme to calculate the total burned surface area in children. Only 52 participants marked the correct choice as the Lactated Ringer's of the fluid given in the first 24 hours. Only 108 correctly recognized inhalation injury. To the question "What is the first intervention that doctors should do at the emergency room to burned children?," 127 participants stated correctly as the assessment of airway maintenance. Among the participants, 124 stated that they use lidocaine pomades when covering burned children's wounds. Incorrect interventions with burned children increase morbidity and mortality. This survey shows that non-burn doctors working in emergency departments have insufficient knowledge about pediatric burns and require further training. Therefore, they should be trained continuously and regularly on the approach to both adult and childhood burns.
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Affiliation(s)
- Sabri Demir
- Ankara Bilkent City Hospital, Children Hospital, Pediatric Burn Centre, Turkey.,Ankara Bilkent City Hospital, Children Hospital, Department of Pediatric Surgery, Turkey
| | - Can Ihsan Oztorun
- Ankara Bilkent City Hospital, Children Hospital, Pediatric Burn Centre, Turkey.,Ankara Yildirim Beyazit University, Medical Faculty, Department of Pediatric Surgery, Turkey
| | - Ahmet Erturk
- Ankara Bilkent City Hospital, Children Hospital, Pediatric Burn Centre, Turkey.,Ankara Bilkent City Hospital, Children Hospital, Department of Pediatric Surgery, Turkey
| | - Dogus Guney
- Ankara Bilkent City Hospital, Children Hospital, Pediatric Burn Centre, Turkey.,Ankara Yildirim Beyazit University, Medical Faculty, Department of Pediatric Surgery, Turkey
| | - Ayse Ertoy
- Ankara Bilkent City Hospital, Children Hospital, Pediatric Burn Centre, Turkey.,Ankara Bilkent City Hospital, Children Hospital, Department of Pediatric Surgery, Turkey
| | - Hayal Doruk
- Ankara Bilkent City Hospital, Children Hospital, Pediatric Burn Centre, Turkey.,Ankara Bilkent City Hospital, Children Hospital, Department of Pediatric Surgery, Turkey
| | - Fatih Tanriverdi
- Ankara Yildirim Beyazit University, Medical Faculty, Department of Emergency Medicine, Turkey
| | - Mujdem Nur Azili
- Ankara Bilkent City Hospital, Children Hospital, Pediatric Burn Centre, Turkey.,Ankara Yildirim Beyazit University, Medical Faculty, Department of Pediatric Surgery, Turkey
| | - Emrah Senel
- Ankara Bilkent City Hospital, Children Hospital, Pediatric Burn Centre, Turkey.,Ankara Yildirim Beyazit University, Medical Faculty, Department of Pediatric Surgery, Turkey
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25
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Yelvington M, Godleski M, Lee AF, Goverman J, Parry I, Herndon DN, Suman OE, Kowalske K, Holavanahalli R, Gibran NS, Esselman PC, Ryan CM, Schneider JC. Contracture Severity at Hospital Discharge in Children: A Burn Model System Database Study. J Burn Care Res 2021; 42:425-433. [PMID: 33247583 DOI: 10.1093/jbcr/iraa169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Contractures can complicate burn recovery. There are limited studies examining the prevalence of contractures following burns in pediatrics. This study investigates contracture outcomes by location, injury, severity, length of stay, and developmental stage. Data were obtained from the Burn Model System between 1994 and 2003. All patients younger than the age of 18 with at least one joint contracture at hospital discharge were included. Sixteen areas of impaired movement from the shoulder, elbow, wrist, hand, hip, knee, and ankle joints were examined. Analysis of variance was used to assess the association between contracture severity, burn size, and length of stay. Age groupings were evaluated for developmental patterns. A P value of less than .05 was considered statistically significant. Data from 225 patients yielded 1597 contractures (758 in the hand) with a mean of 7.1 contractures (median 4) per patient. Mean contracture severity ranged from 17% (elbow extension) to 41% (ankle plantarflexion) loss of movement. Statistically significant associations were found between active range of motion loss and burn size, length of stay, and age groupings. The data illustrate quantitative assessment of burn contractures in pediatric patients at discharge in a multicenter database. Size of injury correlates with range of motion loss for many joint motions, reflecting the anticipated morbidity of contracture for pediatric burn survivors. These results serve as a potential reference for range of motion outcomes in the pediatric burn population, which could serve as a comparison for local practices, quality improvement measures, and future research.
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Affiliation(s)
| | | | - Austin F Lee
- Massachusetts General Hospital, Boston.,University of Massachusetts Medical School, Worcester
| | - Jeremy Goverman
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ingrid Parry
- Shriners Hospital for Children, Northern California/UC Davis Medical Center, Sacramento
| | - David N Herndon
- University of Texas Medical Branch, Shriners Hospitals for Children, Galveston
| | - Oscar E Suman
- University of Texas Southwestern Medical Center, Dallas
| | | | | | | | | | - Colleen M Ryan
- Massachusetts General Hospital, Shriners Hospitals for Children, Boston
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Spaulding Research Institute and Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
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Molloy MJ, Shields W, Stevens MW, Gielen AC. Short-term outcomes in children following emergency department visits for minor injuries sustained at home. Inj Epidemiol 2021; 8:16. [PMID: 33896423 PMCID: PMC8071606 DOI: 10.1186/s40621-021-00307-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/16/2021] [Indexed: 05/31/2023] Open
Abstract
Background Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes. Methods Children (n = 102) aged 0–7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression. Results The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97). Conclusions Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.
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Affiliation(s)
- Matthew J Molloy
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA. .,Present affiliation: Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 9016, OH, 45229, Cincinnati, USA.
| | - Wendy Shields
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center for Injury Research and Policy, Baltimore, USA
| | - Molly W Stevens
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA.,Department of Surgery, Division of Emergency Medicine, University of Vermont Larner College of Medicine, Burlington, USA
| | - Andrea C Gielen
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center for Injury Research and Policy, Baltimore, USA
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27
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Wu Y, Zhao Y, Lin G, Sharma M, Wang Y, Chen L, Wu L. Measures and Effects of Pain Management for Wound Dressing Change in Outpatient Children in Western China. J Pain Res 2021; 14:399-406. [PMID: 33603454 PMCID: PMC7886234 DOI: 10.2147/jpr.s281876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/28/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The present study investigated the pain management of wound dressing change in outpatient children in western China, and the results may provide a reference to improve the pain management of wound dressing change. Methods A cross-sectional survey was performed to investigate the pain management of wound dressing change in outpatient children in western China. A total of 47 hospitals were selected via convenience sampling, and the pain management organization systems, concrete measures and barriers to adequate pain management of these hospitals were investigated. Results More than 70% of these hospitals had established pain management systems, analgesic drug management norms and wound care teams. Nurses were the primary providers for wound dressing change in 48.94% of the hospitals. The assessment, documentation or health education of the pain was not standard in 46.81% of the hospitals. Drug and non-drug analgesia measures were used in most hospitals, however, children did not receive adequate analgesia in 70% of the hospitals. Ibuprofen (30.49%) and lidocaine (29.27%) were commonly used analgesic drugs, and distraction (43.01%) was commonly used as a non-drug analgesia measure. The top three barriers to adequate pain management were medical staff lacking analgesic knowledge (82.98%), family members refusing to use analgesics (61.70%) and low compliance of children (55.32%). Conclusion The concrete measures for the management of wound dressing pain in children are not standardized, and the analgesic effect is poor. In order to improve the pain management of children, Standardized procedures for pain management (pain assessment, analgesia measures, pain documentation and health education) should be strictly followed during wound dressing change, and the identified barriers should be addressed.
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Affiliation(s)
- Yujie Wu
- Department of Nursing, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Chongqing, People's Republic of China
| | - Guangyan Lin
- Department of Outpatient Surgery, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Manoj Sharma
- Environmental & Occupational Health, University of Nevada, Las Vegas, NV, USA
| | - Yan Wang
- Department of Nursing, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Liping Chen
- Department of Nursing, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Liping Wu
- Department of Nursing, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
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28
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Young SR, Duby JJ, Louie EL, Palmieri TL. Impact of Multimodal Analgesia in Critically Ill Burn Patients. J Burn Care Res 2021; 42:986-990. [PMID: 33471091 DOI: 10.1093/jbcr/irab001] [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: 01/01/2023]
Abstract
Opioids are the mainstay of treatment for burn pain. However, these medications may be associated with, respiratory depression, and dependence. Multimodal analgesia is an alternative method that utilizes both opioid and non-opioid medications with different mechanisms. This study examines the impact of multimodal therapy for post-operative pain control in a burn intensive care unit.This was a retrospective cohort study of patients admitted to the burn unit at a tertiary medical center. Consecutively admitted patients with burns greater than or equal to 10% total body surface area and intensive care unit length of stay greater than seven days were eligible for inclusion (2012 - 2018). Patients were excluded if they received an opioid infusion greater than 48 hours. Patients treated with multimodal analgesia were compared to those treated with opioids alone. Data was calculated for 5 days after surgery. There were 98 patients in the non-multimodal group and 97 in the multimodal group. . Mean cumulative opioid dose was lower in the multimodal group (1,028.7 mg vs. 1,423.2 mg, P = 0.0031). Patients with greater than 20% burns had a larger reduction in mean opioid equivalents in the multimodal group (1,106 vs 1,594 mg, P=0.009) compared to patients with burns less than 20% (940 vs. 1,282 mg, P=0.058). There was no difference in mean pain scores on post-operative day 5 (6.2 + 2.2 vs. 5.5 + 2.3 P=0.07) or at intensive care unit discharge (4.7 + 2.4 vs 4.7 + 2.8, P=0.99). The use of multimodal analgesia significantly reduced cumulative opioid equivalent dose without compromising pain control. .
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Affiliation(s)
- Sierra R Young
- Department of Pharmacy Services, University of California Davis Medical Center, Stockton Boulevard, Sacramento, CA, United States of America
| | - Jeremiah J Duby
- Department of Pharmacy Services, University of California Davis Medical Center, Stockton Boulevard, Sacramento, CA, United States of America
| | - Erin L Louie
- Department of Pharmacy Services, University of California Davis Medical Center, Stockton Boulevard, Sacramento, CA, United States of America
| | - Tina L Palmieri
- Firefighters Burn Institute, University of California Davis Medical Center, Stockton Boulevard, Sacramento, CA, United States of America
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Storey K, Kimble RM, Holbert MD. The Management of Burn Pain in a Pediatric Burns-Specialist Hospital. Paediatr Drugs 2021; 23:1-10. [PMID: 33447938 DOI: 10.1007/s40272-020-00434-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
Appropriate pain management for children who have experienced an acute burn injury is critical to improve patient outcomes and reduce potential morbidities. With 60% of our patients being under the age of 4 years, pain management is crucial in reducing pain and anxiety in both patients and parents. It is imperative that appropriate pain relief is commenced from initial contact with healthcare workers as this will affect the success or failure of future wound procedures. Uncontrolled pain can negatively affect a patient, both short and long term. It may cause anticipatory anxiety for future medical procedures, increased pain and anxiety can decrease wound re-epithelialization which can lead to long-term consequences for growth and mobility, and increased pain can also influence the possibility of patients and families displaying signs of post-traumatic stress disorder. Pain management in the form of pharmaceuticals is imperative during burn wound treatment and should incorporate pain relief targeted at both background and procedural pain. It also requires a multimodal, individualized, and targeted approach combining both pharmaceutical and nonpharmaceutical techniques, including cold running water, multimodal distraction devices, hypnotherapy, and bubbles. We discuss the research and knowledge that our center has gained through treating pediatric patients with burns over the last 20 years.
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Affiliation(s)
- Kristen Storey
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, QLD, Australia. .,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, Australia. .,Queensland University of Technology, Brisbane, QLD, Australia. .,Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, 501 Stanley Street, South Brisbane, QLD, 4101, Australia.
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, QLD, Australia.,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
| | - Maleea D Holbert
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, QLD, Australia.,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Richards HW, Shi J, Thakkar RK, Giles S, Wheeler KK, Fabia R. Assessing opioid administration in pediatric burn patients with nonsurgical management. Burns 2020; 47:322-326. [PMID: 33358305 DOI: 10.1016/j.burns.2020.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite the vast literature studying the opioid crisis, sparse data describe this in the pediatric burn population. This study sought to assess patient-level characteristics and their potential effects on opioid administration in nonsurgical pediatric burn inpatients. METHODS Admitted burn patients from 2013 to 2018 with nonsurgical management at an American Burn Association (ABA) verified pediatric burn center were retrospectively identified. Morphine milligram equivalents by weight (MME/kg) per admission were evaluated through a multiple loglinear regression with race, sex, age, total body surface area burned (TBSA), and burn depth as predictors. Simple linear regression was used to evaluate the temporal trend of median opioid utilization. RESULTS A total of 806 patients (55% White, 35% Black, 5% Hispanic, 5% Other) were included. In an adjusted analysis, no differences in opioid administration were seen by sex, burn degree, or for Blacks and Hispanics when compared with Whites. Increased MME/kg was associated with older age (10-18 years; p<0.0001) and larger burns (>5% TBSA burned; p<0.0001). From 2013 to 2018, median MME/kg per admission declined significantly (2013:0.21, 2018:0.09; p=0.0103). CONCLUSIONS Nonsurgical burn patients who were older and presented with larger TBSA experienced marked increases in opioid utilization. Overall, opioid administration decreased over time.
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Affiliation(s)
- Holden W Richards
- Oregon Health and Science University School of Medicine, Portland, OR, United States.
| | - Junxin Shi
- Center for Injury Research and Policy, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States; Center for Pediatric Trauma Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Rajan K Thakkar
- Center for Pediatric Trauma Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, United States; Burn Program, Nationwide Children's Hospital, Columbus, OH, United States
| | - Sheila Giles
- Burn Program, Nationwide Children's Hospital, Columbus, OH, United States
| | - Krista K Wheeler
- Center for Injury Research and Policy, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States; Center for Pediatric Trauma Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Renata Fabia
- Center for Pediatric Trauma Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, United States; Burn Program, Nationwide Children's Hospital, Columbus, OH, United States
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31
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Frear CC, Griffin B, Kimble R. Adequacy of cool running water first aid by healthcare professionals in the treatment of paediatric burns: A cross-sectional study of 4537 children. Emerg Med Australas 2020; 33:615-622. [PMID: 33191592 PMCID: PMC9292905 DOI: 10.1111/1742-6723.13686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 11/27/2022]
Abstract
Objective To determine the adequacy of cool running water first aid provided by healthcare professionals in the early management of children with thermal burn injuries. Methods A cross‐sectional study was undertaken using a prospectively collected registry of children who presented with a thermal burn to the only major paediatric burns centre in Queensland, Australia, from January 2013 to December 2018. Main outcome measures included the type and duration of first aid administered by paramedics, general practitioners and emergency providers at local general hospitals and a children's hospital. In accordance with current Australian guidelines, adequate cooling was defined as 20 min of cool running water within 3 h of the injury. Results Of the 4537 children who presented to the paediatric burns centre, 3261 (71.9%) received adequate first aid, including 1502 (33.1%) at the scene of injury. Paramedics and general practitioners administered adequate cooling to 184 (25.0%) and 52 (24.2%) of their patients, respectively. ED clinicians adhered to guidelines in the treatment of 1019 (56.3%) children at general hospitals and 411 (76.0%) at the children's hospital. Among ED patients who presented with incomplete prior first aid, the risk of inadequate cooling was significantly greater for those transported via ambulance (P < 0.001). Conclusion Deficiencies remain in the cooling of paediatric burns patients at all levels of initial management. There is a need in the healthcare community for improved education regarding the parameters and clinical benefits of cool running water first aid.
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Affiliation(s)
- Cody C Frear
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Bronwyn Griffin
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Brisbane, Queensland, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Paediatric Surgery, Urology, Burns and Trauma, Queensland Children's Hospital, Brisbane, Queensland, Australia
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32
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Effects of a projector-based hybrid virtual reality on pain in young children with burn injuries during hydrotherapy sessions: A within-subject randomized crossover trial. Burns 2020; 46:1571-1584. [DOI: 10.1016/j.burns.2020.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022]
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Hansen JK, Voss J, Ganatra H, Langner T, Chalise P, Stokes S, Bhavsar D, Kovac AL. Sedation and Analgesia During Pediatric Burn Dressing Change: A Survey of American Burn Association Centers. J Burn Care Res 2020; 40:287-293. [PMID: 30844056 DOI: 10.1093/jbcr/irz023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Sedation practices for pediatric burn patients during dressing changes vary between institutions and providers. To better understand the current trends in pediatric sedation practice, a survey was conducted among the members of the American Burn Association (ABA). Questions asked about nonoperating room sedation and analgesia practices for burn patients (ages 0-17) having dressing changes in the intensive care unit, inpatient unit, and outpatient clinics. ABA members providing sedation for pediatric patients undergoing burn dressing changes are diverse. Physician respondents included surgeons, critical care intensivists, and anesthesiologists. Others included physician assistants, nurse anesthetists, nurse practitioners, and sedation credentialed nurses. Opioids for pain control were prescribed by 100% of respondents, but use of adjuvant nonopioid analgesics was utilized <50% of the time. Benzodiazepines and ketamine were prescribed more than twice as often as other sedatives. Many noted that up to 50% of children did not have adequately controlled anxiety and pain with initial sedation plans, and escalation of care was needed to complete dressing changes. Self-reported adverse events were infrequent. In outpatient settings, benzodiazepines, ketamine, oral opioids, and topical lidocaine were used frequently, as were nonpharmacologic methods of distraction and comfort. Sedation in pediatric burn patients is challenging. Responses highlighted areas for improvement regarding pain control during dressing changes and increasing use of multimodal analgesia. Commonly used medications including opioids, benzodiazepine, and ketamine are well established in the treatment of burn patients, as are nonpharmacologic methods. A collaborative effort among institutions is needed to formulate practice guidelines for sedation during burn dressing changes.
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Affiliation(s)
- Jennifer K Hansen
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City
| | - Jordan Voss
- School of Medicine, University of Kansas Medical Center, Kansas City
| | - Hammad Ganatra
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Kansas Medical Center, Kansas City
| | - Travis Langner
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Kansas Medical Center, Kansas City
| | - Prabhakar Chalise
- Department of Biostatistics, University of Kansas Medical Center, Kansas City
| | - Shaun Stokes
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City
| | - Dhaval Bhavsar
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City
| | - Anthony L Kovac
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City
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Tracy LM, Cleland H, Cameron PA, Gabbe BJ. Pain assessment following burn injury in Australia and New Zealand: Variation in practice and its association on in-hospital outcomes. Australas Emerg Care 2020; 24:73-79. [PMID: 32807724 DOI: 10.1016/j.auec.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pain is common following burn injury. Pain assessments are required to ensure appropriate pain management is provided. This study aimed to describe the prevalence and potential variation in practice of validated and documented pain assessment following burn injury in Australian and New Zealand burn units, identify clinical characteristics of patients who receive a pain assessment, and explore the associations between receiving a pain assessment and in-hospital outcomes. METHODS Burns Registry of Australia and New Zealand (BRANZ) admissions data were extracted. Responses to the pain assessment field were presented by contributing burns unit using frequencies and percentages. Demographic, injury severity and event, and in-hospital outcomes data were assessed. RESULTS There were 3009 admissions over the study period; 2481 of these received an assessment. The rate of pain assessment varied considerably between units. Women and adult patients more commonly received a pain assessment. Receiving a pain assessment was associated with a 53% adjusted increase in LOS. CONCLUSIONS There are differences in the profile of patients who receive a pain assessment after burn injury. The findings of this study will be reported back to designated burns units to improve pain assessment rates and patient care.
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Affiliation(s)
- Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia.
| | - Heather Cleland
- Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia; Emergency and Trauma Centre, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea, Wales, United Kingdom
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Abstract
Management of the pediatric burn patient presents a variety of clinical challenges for the pediatric anesthesiologist. Despite the high incidence of burn injuries, standard management strategies are far from universal. The complex physiologic changes presented by burn injuries present airway management and resuscitation challenges and mandate careful consideration of adequate nutritional support. Long hospital stays with frequent operations and dressing changes necessitate creative approaches to anxiolysis and pain control. Underutilized modalities warranting further research include regional anesthesia and nonpharmacologic approaches, such as virtual reality. Further research and collaboration between burn centers are needed to standardize care for this population.
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Bentivegna K, McCollum S, Wu R, Hunter AA. A state-wide analysis of pediatric scald burns by tap water, 2016-2018. Burns 2020; 46:1805-1812. [PMID: 32646547 DOI: 10.1016/j.burns.2020.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Unsafe tap water temperatures (>120 °F) are a risk factor for pediatric burns, which may disproportionally impact low-income, urban communities. We sought to estimate the incidence and demographic characteristics of tap water burns and their association with housing characteristics. METHODS We performed a secondary data analysis to summarize emergency department discharge records from 2016 to 2018 involving children <18 years with an ICD-10-CM code for tap water burn (X11), and town-level housing data from the American Community Survey. Unpaired student's t-test and spearman's correlation analysis were performed for comparative analyses. RESULTS A total of 146 tap water burn visits were identified, representing an incidence of 2 per 10,000 ED visits. The majority of cases were male, non-Hispanic White, of public insurance type, and from an urban CT town. The median age was 3 years, with 58% of cases <5 years. Towns with at least one tap water burn had a significantly higher average percentage of multi-family unit and renter housing as compared to towns with no tap water burns (p < 0.0001). CONCLUSIONS Our results identified a significant number of tap water burns in children. Primary prevention efforts targeting education or regulation of water temperatures may work to reduce burns in underserved areas.
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Affiliation(s)
- Kathryn Bentivegna
- University of Connecticut School of Medicine, Farmington, CT, United States
| | | | - Rong Wu
- Biostatistics Center, Connecticut Convergence Institute for Translation in Regenerative Engineering, UConn Health, Farmington, CT, United States
| | - Amy A Hunter
- Injury Prevention Center, Connecticut Children's and Hartford Hospital, Hartford, CT, United States; Department of Pediatrics, University of Connecticut, School of Medicine, Farmington, CT, United States; Department of Public Health Sciences, School of Medicine, Farmington, CT, United States; Trinity College, Hartford, CT, United States.
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Pediatric burn resuscitation, management, and recovery for the pediatric anesthesiologist. Curr Opin Anaesthesiol 2020; 33:360-367. [PMID: 32371635 DOI: 10.1097/aco.0000000000000859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this article is to summarize literature in pediatric burn resuscitation and management that is relevant to the pediatric anesthesiologist. The scope of the literature is expanding as long-term survival in even the most critically ill, burn-injured children has increased. RECENT FINDINGS Longstanding variations in the care of burn-injured children exist despite decades of experience in burn care management. There seems to be a discomfort outside major burn centers in the triage, evaluation, and assessment of burned children. This is evidenced by the prevalence of 'unnecessary intubations', continued overestimation of total body surface area injured, and subsequent fluid administration disproportionate to injury leading to over-resuscitation. Techniques, such as virtual reality and regional anesthesia are increasingly available and serve adjuncts to pharmacologic therapies for anxiolysis and analgesia. Such techniques reduce opioid utilization while maintaining patient comfort and satisfaction particularly during wound dressing changes. Questions about transfusion threshold and ratio of blood products remain topics of ongoing research. SUMMARY Literature review continues to reveal underpowered or retrospective analyses of these very important questions. Public health burden caused by burns warrants rigorous, prospective studies to take the best care of these patients and portend the best long-term outcomes. Collaboration amongst pediatric anesthesiologists who care for these children is necessary to develop and execute powered studies to answer important questions.
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Krasnoff CC, Grigorian A, Chin T, Joe V, Kong A, Barrios C, Kuza CM, Nahmias J. Pediatric burn-trauma patients have increased length of stay compared to trauma-only patients: A propensity matched analysis. Burns 2020; 47:78-83. [PMID: 33293153 DOI: 10.1016/j.burns.2020.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Trauma is the leading cause of mortality in children. Burn injury involves intensive resources, especially in pediatric patients. We hypothesized that among pediatric trauma patients, combined burn-trauma (BT) patients have increased length of stay (LOS) and mortality compared to trauma-only (T) patients. METHODS The Pediatric Trauma Quality Improvement Program (2014-2016) was queried and BT patients were 1:2 propensity-score-matched to T patients based on age, gender, hypotension on admission, injury type and severity. RESULTS 93 BT patients were matched to 186 T patients. There were no differences in matched characteristics. BT patients had a longer median LOS (4 vs 2 days, p<0.001) with no difference in mortality (1.1% vs 1.1%, p=1.00), intensive care unit (ICU) LOS (3 vs 3 days, p=0.55), or complications including decubitus ulcer (0% vs 1.1%, p=0.32), deep vein thrombosis (0% vs 0.5%, p=0.48), extremity compartment syndrome (1.1% vs 0%, p=0.16), and urinary tract infection (1.1% vs 1.1%, p=1.00). CONCLUSION Pediatric BT patients had twice the LOS compared to a matched group of pediatric T patients. There was no difference between the cohorts in ICU LOS, complications or mortality rate. When evaluating risk-stratified quality metrics such as LOS, concomitant burn injury should be incorporated.
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Affiliation(s)
- Chloe C Krasnoff
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
| | - Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Theresa Chin
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Victor Joe
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Allen Kong
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Cristobal Barrios
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Catherine M Kuza
- University of Southern California, Department of Anesthesiology, Los Angeles, CA, USA
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
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Efficacy of Silicone Gel versus Silicone Gel Sheet in Hypertrophic Scar Prevention of Deep Hand Burn Patients with Skin Graft: A Prospective Randomized Controlled Trial and Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3190. [PMID: 33173695 PMCID: PMC7647509 DOI: 10.1097/gox.0000000000003190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/14/2020] [Indexed: 12/27/2022]
Abstract
Burn injuries are burdensome to the public health system. Hypertrophic scars are the most common undesirable sequelae associated with burn scar contracture, resulting in reduced hand function. This study compared 2 different forms of silicone combined with pressure garment (PG) to determine the efficacy in hypertrophic scar prevention in hand burns.
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Khan A, Parikh M, Minhajuddin A, Williams T, Abrams R, Kandil E, Ambardekar A. Opioid prescribing practices in a pediatric burn tertiary care facility: Is it time to change? Burns 2020; 46:219-224. [DOI: 10.1016/j.burns.2019.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/31/2019] [Accepted: 07/10/2019] [Indexed: 11/29/2022]
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Hoffman HG, Rodriguez RA, Gonzalez M, Bernardy M, Peña R, Beck W, Patterson DR, Meyer WJ. Immersive Virtual Reality as an Adjunctive Non-opioid Analgesic for Pre-dominantly Latin American Children With Large Severe Burn Wounds During Burn Wound Cleaning in the Intensive Care Unit: A Pilot Study. Front Hum Neurosci 2019; 13:262. [PMID: 31440148 PMCID: PMC6694842 DOI: 10.3389/fnhum.2019.00262] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/11/2019] [Indexed: 12/18/2022] Open
Abstract
Background/Aim: Using a within-subjects, within-wound care design, this pilot study tested for the first time, whether immersive virtual reality (VR) can serve as an adjunctive non-opioid analgesic for children with large severe burn wounds during burn wound cleaning in the ICU, in a regional burn center in the United States, between 2014–2016. Methods: Participants included 48 children from 6 years old to 17 years of age with >10% TBSA burn injuries reporting moderate or higher worst pain during no VR on Day 1. Forty-four of the 48 children were from developing Latin American countries. Patients played adjunctive SnowWorld, an interactive 3D snowy canyon in virtual reality during some portions of wound care, vs. No VR during comparable portions of the same wound care session (initial treatment condition randomized). Using Graphic Rating scales, children's worst pain ratings during “No VR” (treatment as usual pain medications) vs. their worst pain during “Yes VR” was measured during at least 1 day of wound care, and was measured for up to 10 study days the patient used VR. Results: VR significantly reduced children's “worst pain” ratings during burn wound cleaning procedures in the ICU on Day 1. Worst pain during No VR = 8.52 (SD = 1.75) vs. during Yes VR = 5.10 (SD = 3.27), t(47) = 7.11, p < 0.001, SD = 3.33, CI = 2.45–4.38, Cohen's d = 1.03 (indicating large effect size). Patients continued to report the predicted pattern of lower pain and more fun during VR, during multiple sessions. Conclusion: Immersive virtual reality can help reduce the pain of children with large severe burn wounds during burn wound cleaning in the Intensive Care Unit. Additional research and development is recommended.
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Affiliation(s)
- Hunter G Hoffman
- Department of Mechanical Engineering, College of Engineering, University of Washington, Seattle, WA, United States
| | - Robert A Rodriguez
- Psychiatry and Behavioral Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States.,Shriners Hospitals for Children, Galveston, TX, United States
| | - Miriam Gonzalez
- Psychiatry and Behavioral Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States.,Shriners Hospitals for Children, Galveston, TX, United States
| | - Mary Bernardy
- Shriners Hospitals for Children, Galveston, TX, United States
| | - Raquel Peña
- Psychiatry and Behavioral Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States.,Shriners Hospitals for Children, Galveston, TX, United States
| | - Wanda Beck
- Shriners Hospitals for Children, Galveston, TX, United States
| | - David R Patterson
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Walter J Meyer
- Psychiatry and Behavioral Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States.,Shriners Hospitals for Children, Galveston, TX, United States
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Brown EA, De Young A, Kimble R, Kenardy J. The role of parental acute psychological distress in paediatric burn re-epithelialization. Br J Health Psychol 2019; 24:876-895. [PMID: 31389153 DOI: 10.1111/bjhp.12384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/24/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Following a paediatric burn, parents commonly experience high levels of acute psychological distress, which has been shown to increase child psychological distress as well as child procedural distress. The influence of psychological stress and perceived pain on wound healing has been demonstrated in several laboratory and medical populations. This paper investigates the influence of parental acute psychological distress and procedural behaviour on the child's rate of re-epithelialization, after controlling for child procedural distress. DESIGN A prospective observational study with longitudinal outcome. METHODS Eighty-three parents of children 1-6 years old reported acute psychological distress (post-traumatic stress symptoms [PTSS], guilt, pre-procedural fear, general anxiety/depression symptoms) in relation to their child's burn. A researcher observed parent-child behaviour at the first dressing change, and parents and nurses reported child procedural distress (pre-, peak-, and post-procedural pain and fear). These variables, along with demographic and injury information, were tested for predicting time to re-epithelialization. Date of re-epithelialization was determined by the treating consultant. RESULTS Days to re-epithelialization ranged from 3 to 35 days post-injury. A hierarchical multiple regression analysis found wound depth and size significantly accounted for 28% of the variance in time to re-epithelialization. In Block 2, child peak-procedural pain significantly accounted for 6% additional variance. In Block 3, parental PTSS significantly accounted for 5% additional variance. CONCLUSIONS Parental PTSS appears to be an important but under-recognized factor that may influence their child's burn re-epithelialization. Further investigation is required to understand the mechanisms contributing to this association. Statement of contribution What is already known on this subject? Psychological stress delays wound healing, and this relationship has been found in paediatric burn populations with procedural pain. Parental psychological stress is often present after a child's burn and is related to the child's procedural coping and distress. What does this study add? Parental post-traumatic stress is related to delayed child burn re-epithelialization. This association is in addition to procedural pain delaying re-epithelialization.
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Affiliation(s)
- Erin A Brown
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, South Brisbane, Qld, Australia.,School of Psychology, The University of Queensland, St Lucia, Qld, Australia
| | - Alexandra De Young
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, South Brisbane, Qld, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, South Brisbane, Qld, Australia.,Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Children's Health Queensland, South Brisbane, Qld, Australia
| | - Justin Kenardy
- School of Psychology, The University of Queensland, St Lucia, Qld, Australia
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Furness PJ, Phelan I, Babiker NT, Fehily O, Lindley SA, Thompson AR. Reducing Pain During Wound Dressings in Burn Care Using Virtual Reality: A Study of Perceived Impact and Usability With Patients and Nurses. J Burn Care Res 2019; 40:878-885. [DOI: 10.1093/jbcr/irz106] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AbstractBurns patients often suffer severe pain during interventions such as dressing changes, even with analgesia. Virtual Reality (VR) can be used to distract patients and reduce pain. However, more evidence is needed from the patients and staff using the technology about its use in clinical practice and the impact of different VR strategies. This small-scale qualitative study explored patient and staff perceptions of the impact and usability of active and passive VR during painful dressing changes. Five patients took part in three observed dressing changes—one with an active VR scenario developed for the study, one with passive VR, and one with no VR—following which they were interviewed about their experiences. Three nurses who performed the dressing changes participated in a focus group. Thematic analysis of the resulting data generated four themes: “Caution replaced by contentment,” “Distraction and implications for pain and wound care,” “Anxiety, control and enjoyment,” and “Preparation and communication concerns.” Results suggested that user-informed active VR was acceptable to burn patients, helped manage their perceived pain, and was both usable and desirable within the clinical environment. Further testing with larger samples is now required.
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Affiliation(s)
- Penny J Furness
- Department of Psychology, Sociology and Politics, Faculty of Social Sciences and Humanities, Sheffield Hallam University, Sheffield, UK
| | - Ivan Phelan
- Cultural, Communication and Computing Research Institute, Faculty of Science, Technology and Arts, Sheffield Hallam University, Sheffield, UK
| | - Nathan T Babiker
- Department of Psychological Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Orla Fehily
- Paediatric Psychology, Evelina London Children’s Hospital, London, UK
| | - Shirley A Lindley
- ultural, Communication and Computing Research Institute, Faculty of Science, Technology and Arts, Sheffield Hallam University, Sheffield, UK
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Luiz T, Eyer F, Matthes G. Patienten mit Brandverletzungen. Notf Rett Med 2019. [DOI: 10.1007/s10049-018-0561-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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46
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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] [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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Phelan I, Furness PJ, Fehily O, Thompson AR, Babiker NT, Lamb MA, Lindley SA. A Mixed-Methods Investigation Into the Acceptability, Usability, and Perceived Effectiveness of Active and Passive Virtual Reality Scenarios in Managing Pain Under Experimental Conditions. J Burn Care Res 2018; 40:85-90. [DOI: 10.1093/jbcr/iry052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ivan Phelan
- Cultural, Communication and Computing Research Institute, Faculty of Science, Technology and Arts, Sheffield Hallam University, UK
| | - Penny J Furness
- Department of Psychology, Sociology and Politics, Faculty of Social Sciences and Humanities, Sheffield Hallam University, UK
| | - Orla Fehily
- Department of Psychological Services, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | | | - Nathan T Babiker
- Department of Psychological Services, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Martin A Lamb
- Department of Psychology, Sociology and Politics, Faculty of Social Sciences and Humanities, Sheffield Hallam University, UK
| | - Shirley A Lindley
- Cultural, Communication and Computing Research Institute, Faculty of Science, Technology and Arts, Sheffield Hallam University, UK
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Herlihy CR, Barry C. Anesthesia and Burns. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Won AS, Bailey J, Bailenson J, Tataru C, Yoon IA, Golianu B. Immersive Virtual Reality for Pediatric Pain. CHILDREN (BASEL, SWITZERLAND) 2017; 4:E52. [PMID: 28644422 PMCID: PMC5532544 DOI: 10.3390/children4070052] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/24/2017] [Accepted: 06/16/2017] [Indexed: 12/29/2022]
Abstract
Children must often endure painful procedures as part of their treatment for various medical conditions. Those with chronic pain endure frequent or constant discomfort in their daily lives, sometimes severely limiting their physical capacities. With the advent of affordable consumer-grade equipment, clinicians have access to a promising and engaging intervention for pediatric pain, both acute and chronic. In addition to providing relief from acute and procedural pain, virtual reality (VR) may also help to provide a corrective psychological and physiological environment to facilitate rehabilitation for pediatric patients suffering from chronic pain. The special qualities of VR such as presence, interactivity, customization, social interaction, and embodiment allow it to be accepted by children and adolescents and incorporated successfully into their existing medical therapies. However, the powerful and transformative nature of many VR experiences may also pose some risks and should be utilized with caution. In this paper, we review recent literature in pediatric virtual reality for procedural pain and anxiety, acute and chronic pain, and some rehabilitation applications. We also discuss the practical considerations of using VR in pediatric care, and offer specific suggestions and information for clinicians wishing to adopt these engaging therapies into their daily clinical practice.
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Affiliation(s)
- Andrea Stevenson Won
- Department of Communication, Cornell University, 417 Mann Library Building, Ithaca, NY 14853, USA.
| | - Jakki Bailey
- Department of Anesthesiology and Perioperative Medicine, Stanford University, 300 Pasteur Dr. H3580A, Stanford, CA 94305, USA.
| | - Jeremy Bailenson
- Department of Anesthesiology and Perioperative Medicine, Stanford University, 300 Pasteur Dr. H3580A, Stanford, CA 94305, USA.
| | - Christine Tataru
- Department of Anesthesiology and Perioperative Medicine, Stanford University, 300 Pasteur Dr. H3580A, Stanford, CA 94305, USA.
| | - Isabel A Yoon
- Department of Anesthesiology and Perioperative Medicine, Stanford University, 300 Pasteur Dr. H3580A, Stanford, CA 94305, USA.
| | - Brenda Golianu
- Department of Anesthesiology and Perioperative Medicine, Stanford University, 300 Pasteur Dr. H3580A, Stanford, CA 94305, USA.
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