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Greenhalgh DG, Hill DM, Burmeister DM, Gus EI, Cleland H, Padiglione A, Holden D, Huss F, Chew MS, Kubasiak JC, Burrell A, Manzanares W, Gómez MC, Yoshimura Y, Sjöberg F, Xie WG, Egipto P, Lavrentieva A, Jain A, Miranda-Altamirano A, Raby E, Aramendi I, Sen S, Chung KK, Alvarez RJQ, Han C, Matsushima A, Elmasry M, Liu Y, Donoso CS, Bolgiani A, Johnson LS, Vana LPM, de Romero RVD, Allorto N, Abesamis G, Luna VN, Gragnani A, González CB, Basilico H, Wood F, Jeng J, Li A, Singer M, Luo G, Palmieri T, Kahn S, Joe V, Cartotto R. Surviving Sepsis After Burn Campaign. Burns 2023; 49:1487-1524. [PMID: 37839919 DOI: 10.1016/j.burns.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes. METHODS The International Society for Burn Injuries (ISBI) reached out to regional or national burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific "patient/population, intervention, comparison and outcome" (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign [1]. SSABC participants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create "statements" based on the literature. The "summary statements" were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or "no consensus" was reported. RESULTS The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as "static" comments but should rather be used as guidelines for future testing of the best treatments for sepsis in burn patients. They should be updated on a regular basis. CONCLUSION Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients.
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Affiliation(s)
- David G Greenhalgh
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA.
| | - David M Hill
- Department of Clinical Pharmacy & Translational Scre have been several studies that have evaluatedience, College of Pharmacy, University of Tennessee, Health Science Center; Memphis, TN, USA
| | - David M Burmeister
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Eduardo I Gus
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children; Department of Surgery, University of Toronto, Toronto, Canada
| | - Heather Cleland
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Alex Padiglione
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Dane Holden
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Fredrik Huss
- Department of Surgical Sciences, Plastic Surgery, Uppsala University/Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - John C Kubasiak
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Aidan Burrell
- Department of Epidemiology and Preventative Medicine, Monash University and Alfred Hospital, Intensive Care Research Center (ANZIC-RC), Melbourne, Australia
| | - William Manzanares
- Department of Critical Care Medicine, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - María Chacón Gómez
- Division of Intensive Care and Critical Medicine, Centro Nacional de Investigacion y Atencion de Quemados (CENIAQ), National Rehabilitation Institute, LGII, Mexico
| | - Yuya Yoshimura
- Department of Emergency and Critical Care Medicine, Hachinohe City Hospital, Hachinohe, Japan
| | - Folke Sjöberg
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Wei-Guo Xie
- Institute of Burns, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, China
| | - Paula Egipto
- Centro Hospitalar e Universitário São João - Burn Unit, Porto, Portugal
| | | | | | | | - Ed Raby
- Infectious Diseases Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | | | - Soman Sen
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Chunmao Han
- Department of Burn and Wound Repair, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Asako Matsushima
- Department of Emergency and Critical Care, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Moustafa Elmasry
- Department of Hand, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
| | - Yan Liu
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Carlos Segovia Donoso
- Intensive Care Unit for Major Burns, Mutual Security Clinical Hospital, Santiago, Chile
| | - Alberto Bolgiani
- Department of Surgery, Deutsches Hospital, Buenos Aires, Argentina
| | - Laura S Johnson
- Department of Surgery, Emory University School of Medicine and Grady Health System, Georgia
| | - Luiz Philipe Molina Vana
- Disciplina de Cirurgia Plastica da Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Nikki Allorto
- Grey's Hospital Pietermaritzburg Metropolitan Burn Service, University of KwaZulu Natal, Pietermaritzburg, South Africa
| | - Gerald Abesamis
- Alfredo T. Ramirez Burn Center, Division of Burns, Department of Surgery, University of Philippines Manila - Philippine General Hospital, Manila, Philippines
| | - Virginia Nuñez Luna
- Unidad Michou y Mau Xochimilco for Burnt Children, Secretaria Salud Ciudad de México, Mexico
| | - Alfredo Gragnani
- Disciplina de Cirurgia Plastica da Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Carolina Bonilla González
- Department of Pediatrics and Intensive Care, Pediatric Burn Unit, Clinical Studies and Clinical Epidemiology Division, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Hugo Basilico
- Intensive Care Area - Burn Unit - Pediatric Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Fiona Wood
- Department of Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - James Jeng
- Department of Surgery, University of California, Irvine, CA, USA
| | - Andrew Li
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Mervyn Singer
- Department of Intensive Care Medicine, University College London, London, United Kingdom
| | - Gaoxing Luo
- Institute of Burn Research, Southwest Hospital, Army (Third Military) Medical University, Chongqing, China
| | - Tina Palmieri
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Steven Kahn
- The South Carolina Burn Center, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Victor Joe
- Department of Surgery, University of California, Irvine, CA, USA
| | - Robert Cartotto
- Department of Surgery, Sunnybrook Medical Center, Toronto, Ontario, Canada
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Xu C, Xia Y, Jia Z, Wang S, Zhao T, Wu L. The curative effect of Shenfu-injection in the treatment of burn sepsis and its effect on the patient's immune function, HMGB, and vWF. Am J Transl Res 2022; 14:2428-2435. [PMID: 35559405 PMCID: PMC9091091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/23/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate and analyze the immune regulatory effect of Shenfu-Injection (SFI) on patients with burn-injured sepsis by monitoring the serum level of high mobility group box 1 (HMGB1) and von Willebrand factor (vWF). METHODS In this retrospective study, the Acute Physiology and Chronic Health Evaluation (APACHE II) score, Marshall score, peripheral blood T lymphocyte count, and NK cell concentration, levels of cytokines such as HMGB-1, and vWF in peripheral blood before and after treatment in patients from the control group (convention treatments, n=51) and the observation group (convention treatments plus SFI treatment, n=57) were analyzed. The prognosis of the two groups of patients at 28 days was analyzed and compared. RESULTS After treatment, APACHE II score, Marshall score, IL-6, CPR, HMGB-1, and vWF in patients from the two groups decreased greatly when compared with those before the treatment (P<0.05). The APACHE II score, Marshall score, IL-6, CPR, HMGB-1, and vWF in the group for observation were significantly lower (P<0.05) than those in the control group. Concentrations of CD3+, CD4+, and NK cells in these two groups after 7 days of treatment were greatly higher than those before the treatment (P<0.05). Concentrations of CD3+, CD4+, and NK cells in the observation group were higher than those in the control group after treatment (P<0.05). There was no significant difference in terms of mortality between these two groups after 28 days (P<0.05). The average survival time of the non-survivors in the observation group was significantly longer than that in the control group (P<0.05). CONCLUSION SFI can effectively improve the immunity of patients with burn-injured sepsis, reduce the expression of cytokines such as HMGB and vWF, and is of great help for the improvement of clinical prognosis.
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Affiliation(s)
- Chuanzhen Xu
- Department of Burn and Plastic Surgery, Binzhou Medical University HospitalBinzhou 256603, Shandong, China
| | - Yongfu Xia
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University HospitalBinzhou 256603, Shandong, China
| | - Zhuting Jia
- Department of Emergency Medicine, Binzhou Medical University HospitalBinzhou 256603, Shandong, China
| | - Shasha Wang
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University HospitalBinzhou 256603, Shandong, China
| | - Tongzhen Zhao
- Department of Oncology, Binzhou Municipal Hospital of Traditional Chinese MedicineBinzhou 256603, Shandong, China
| | - Liqiang Wu
- Department of Emergency Medicine, Binzhou Medical University HospitalBinzhou 256603, Shandong, China
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Rech MA, Mosier MJ, McConkey K, Zelisko S, Netzer G, Kovacs EJ, Afshar M. Outcomes in Burn-Injured Patients Who Develop Sepsis. J Burn Care Res 2020; 40:269-273. [PMID: 30805641 DOI: 10.1093/jbcr/irz017] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study examines health outcomes in burn patients with sepsis. We hypothesized that burn patients with sepsis would have an increased odds risk for in-hospital death and longer intensive care unit (ICU) stays. This was a retrospective cohort of consecutive patients admitted to the burn ICU with total BSA (TBSA) ≥10% and/or inhalation injury between January 2008 and March 2015. Overall 407 burn patients were included; the case-rate for sepsis was 39.1% (n = 159); 20.1% (n = 82) patients were septic and 18.9% (n = 77) patients experienced septic shock. Patients with septic shock had the highest mortality rate (13.31% no sepsis vs 3.7% sepsis vs 49.4% septic shock, P < .01). Median 28-day ICU-free days was higher in patients without sepsis (23 days [Interquartile range (IQR) 14-27] no sepsis vs 0 days [IQR 0-10] sepsis vs 0 days [IQR 0-0] septic shock, P < .01). Sepsis (with or without shock) increased odds of in-hospital death (odds ratio 7.04, 95% confidence interval 1.93-25.7) in reference to the no sepsis group. With each incremental Sequential Organ Failure Assessment (SOFA) score or 10% TBSA increase, the odds risk for in-hospital death increased by 56 and 75%, respectively. Our study characterized outcomes in patients with sepsis after severe burn injury. The odds risk for in-hospital death was greater in patients with sepsis, increasing burn severity according to TBSA and SOFA score.
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Affiliation(s)
- Megan A Rech
- Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois.,Department of Emergency Medicine, Loyola University Medical Center
| | - Michael J Mosier
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Kevin McConkey
- Stritch School of Medicine, Loyola University Chicago, Illinois
| | - Susan Zelisko
- Stritch School of Medicine, Loyola University Chicago, Illinois
| | - Giora Netzer
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Elizabeth J Kovacs
- Division of GI, Trauma and Endocrine Surgery, Department of Surgery and the Mucosal Inflammation Program at the University of Colorado Denver
| | - Majid Afshar
- Division of Pulmonary and Critical Care Medicine, Loyola University Chicago, Illinois.,Department of Public Health Sciences, Loyola University Chicago, Illinois
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Rogobete AF, Sandesc D, Papurica M, Stoicescu ER, Popovici SE, Bratu LM, Vernic C, Sas AM, Stan AT, Bedreag OH. The influence of metabolic imbalances and oxidative stress on the outcome of critically ill polytrauma patients: a review. BURNS & TRAUMA 2017; 5:8. [PMID: 28286784 PMCID: PMC5341432 DOI: 10.1186/s41038-017-0073-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/23/2017] [Indexed: 05/03/2023]
Abstract
The critically ill polytrauma patient presents with a series of associated pathophysiologies secondary to the traumatic injuries. The most important include systemic inflammatory response syndrome (SIRS), sepsis, oxidative stress (OS), metabolic disorders, and finally multiple organ dysfunction syndrome (MODS) and death. The poor outcome of these patients is related to the association of the aforementioned pathologies. The nutrition of the critically ill polytrauma patient is a distinct challenge because of the rapid changes in terms of energetic needs associated with hypermetabolism, sepsis, SIRS, and OS. Moreover, it has been proven that inadequate nutrition can prolong the time spent on a mechanical ventilator and the length of stay in an intensive care unit (ICU). A series of mathematical equations can predict the energy expenditure (EE), but they have disadvantages, such as the fact that they cannot predict the EE accurately in the case of patients with hypermetabolism. Indirect calorimetry (IC) is another method used for evaluating and monitoring the energy status of critically ill patients. In this update paper, we present a series of pathophysiological aspects associated with the metabolic disaster affecting the critically ill polytrauma patient. Furthermore, we present different non-invasive monitoring methods that could help the intensive care physician in the adequate management of this type of patient.
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Affiliation(s)
- Alexandru Florin Rogobete
- Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Str. Eftimie Murgu Nr. 2, Timisoara, 300041 Timis Romania
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Bd. Liviu Rebreanu Nr.156, Timisoara, 300736 Timis Romania
| | - Dorel Sandesc
- Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Str. Eftimie Murgu Nr. 2, Timisoara, 300041 Timis Romania
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Bd. Liviu Rebreanu Nr.156, Timisoara, 300736 Timis Romania
| | - Marius Papurica
- Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Str. Eftimie Murgu Nr. 2, Timisoara, 300041 Timis Romania
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Bd. Liviu Rebreanu Nr.156, Timisoara, 300736 Timis Romania
| | - Emil Robert Stoicescu
- Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Str. Eftimie Murgu Nr. 2, Timisoara, 300041 Timis Romania
| | - Sonia Elena Popovici
- Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Str. Eftimie Murgu Nr. 2, Timisoara, 300041 Timis Romania
| | - Lavinia Melania Bratu
- Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, Str. Eftimie Murgu Nr. 2, Timisoara, 300041 Timis Romania
| | - Corina Vernic
- Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Str. Eftimie Murgu Nr. 2, Timisoara, 300041 Timis Romania
| | - Adriana Mariana Sas
- Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Str. Eftimie Murgu Nr. 2, Timisoara, 300041 Timis Romania
| | - Adrian Tudor Stan
- Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, Str. Eftimie Murgu Nr. 2, Timisoara, 300041 Timis Romania
| | - Ovidiu Horea Bedreag
- Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Str. Eftimie Murgu Nr. 2, Timisoara, 300041 Timis Romania
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, Bd. Liviu Rebreanu Nr.156, Timisoara, 300736 Timis Romania
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