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Fisher MD, Norbury W. Pediatric Burns: From Acute Care Through Reconstruction in 2024. Clin Plast Surg 2024; 51:379-390. [PMID: 38789147 DOI: 10.1016/j.cps.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Children are disproportionately affected by burn injuries. Differences between adult and pediatric burns range from epidemiologic characteristics to pathophysiological considerations, which vary between different age subgroups. All these factors must be considered in each phase of burn care. This article reviews the most important aspects of the management of a pediatric burned patient starting from the acute through reconstructive phases.
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Affiliation(s)
- Mark D Fisher
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, 4940 Eastern Avenue Suite, P3-4-11, JHBMC Pavilion Building, Baltimore, MD 21224, USA; Bayview Adult Burn Center.
| | - William Norbury
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, 4940 Eastern Avenue Suite, P3-4-11, JHBMC Pavilion Building, Baltimore, MD 21224, USA. https://twitter.com/markdfishermd
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Rousseau AF, Fadeur M, Fauville JP, Hans N, Martin F, Misset B. Determination of energy requirements after minor burns using indirect calorimetry: A descriptive cohort study. JPEN J Parenter Enteral Nutr 2024; 48:284-290. [PMID: 38400637 DOI: 10.1002/jpen.2614] [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: 08/17/2023] [Revised: 02/02/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Minor burns could be associated with moderate hypermetabolism. In this study, the primary outcome was measured energy expenditure (mEE) determined by indirect calorimetry in patients with minor burns. We also compared mEE with predictive values and actual energy intakes. METHODS Adults with minor burns exclusively treated on an outpatient basis were included. During the week following injury, a dietitian performed indirect calorimetry (Q-NRG in canopy mode), calculated the estimated energy expenditure (eEE) based on the Harris-Benedict (HB) and Henry formulas, and evaluated daily energy intakes using a food anamnesis. RESULTS Forty-nine patients (59.2% male; median age: 35 [interquartile range: 29-46.5] years; body mass index [BMI]: 26.2 [22.3-29.6] kg/m2; burn surface area [BSA]: 1.5% [1%-2%]) were included 4 (2-6) days after injury. The mEE was 1863 (1568-2199) kcal or 25 (22.4-28.5) kcal/kg and 1838 (1686-2026) kcal or 26.1 (23.7-27.7) kcal/kg in patients who were respectively fasting for >10 h or not (P = 0.991 or P = 0.805). The total mEE was 104% (95%-116%) and 108% (99%-122%) of the total eEE using the HB and Henry formulas, respectively, with diet-induced thermogenesis and physical activity level. Hypermetabolism (ie, oxygen consumption at rest ≥3.5 ml/kg/min) was observed in 21/49 (42.9%) patients. Energy intakes corresponded to 71% (60%-86%) of the total mEE. CONCLUSION Performing indirect calorimetry in adults with minor burns revealed that ≥40% of the tested adults presented a hypermetabolism and that their mEE was not covered by their energy intakes.
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Affiliation(s)
- Anne-Françoise Rousseau
- Department of Intensive Care and Burn Centre, University Hospital, University of Liège, Liège, Belgium
- GIGA-Research, GIGA-I3 Thematic Unit, Inflammation and Enhanced Rehabilitation Laboratory (Intensive Care), University of Liège, Liège, Belgium
| | - Marjorie Fadeur
- Multidisciplinary Nutrition Team, University Hospital, University of Liège, Liège, Belgium
| | - Jean-Philippe Fauville
- Department of Intensive Care and Burn Centre, University Hospital, University of Liège, Liège, Belgium
| | - Nadine Hans
- Department of Plastic Surgery and Burn Centre, University Hospital, University of Liège, Liège, Belgium
| | - François Martin
- Department of Plastic Surgery and Burn Centre, University Hospital, University of Liège, Liège, Belgium
| | - Benoit Misset
- Department of Intensive Care and Burn Centre, University Hospital, University of Liège, Liège, Belgium
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Zhu Z, Xu B, Shao J, Wang S, Jin R, Weng T, Xia S, Zhang W, Yang M, Han C, Wang X. Use of the Braden Scale to Predict Injury Severity in Mass Burn Casualties. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022; 28:e934039. [PMID: 35105848 PMCID: PMC8820233 DOI: 10.12659/msm.934039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Mass burn casualties impose an enormous burden on triage systems. The triage capacity of the Braden Scale for detecting injury severity has not been evaluated in mass burn casualties. Material/Methods The New Injury Severity Score (NISS) was used to dichotomize the injury severity of patients. The Braden Scale and other potentially indicative measurement tools were evaluated using univariate analysis and multivariate logistic regression. The relationships between the Braden Scale and other continuous variables with injury severity were further explored by correlation analysis and fitted with regression models. Receiver operating characteristic (ROC) curve analysis was used to validate triage capacity and compare prognostic accuracy. Results A total of 160 hospitalized patients were included in our study; 37 were severely injured, and 123 were not. Injury severity was independently associated with the Numerical Rating Scale (adjusted OR, 1.816; 95% CI, 1.035–3.187) and Braden Scale (adjusted OR, 0.693; 95% CI, 0.564–0.851). The ROC curve of the fitted quadratic model of the Braden Scale was 0.896 (0.840–0.953), and the cut-off value was 17. The sensitivity was 81.08% (64.29–91.44%) and the specificity was 82.93% (74.85–88.89%). Comparison of ROC curves demonstrated an infinitesimal difference between the Braden Scale and NISS for predicting 30-day hospital discharge (Z=0.291, P=0.771) and Intensive Care Unit admission (Z=2.016, P=0.044). Conclusions The Braden Scale is a suitable triage tool for predicting injury severity and forecasting disability-related outcomes in patients affected by mass burn casualty incidents.
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Affiliation(s)
- Zhikang Zhu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Bin Xu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Jiaming Shao
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Shuangshuang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland).,Wenling First People's Hospital, Taizhou, Zhejiang, China (mainland)
| | - Ronghua Jin
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Tingting Weng
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Sizhan Xia
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Wei Zhang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Min Yang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Chunmao Han
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Xingang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China (mainland).,College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
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Wang ZE, Zheng JJ, Bin Feng J, Wu D, Su S, Yang YJ, Wei Y, Chen ZH, Peng X. Glutamine relieves the hypermetabolic response and reduces organ damage in severe burn patients: A multicenter, randomized controlled clinical trial. Burns 2021; 48:1606-1617. [PMID: 34973853 DOI: 10.1016/j.burns.2021.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 11/07/2021] [Accepted: 12/15/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Severe burns can cause a hypermetabolic response and organ damage. Glutamine is a conditionally essential amino acid with various pharmacological effects. In this study, whether glutamine could alleviate the hypermetabolic response and maintain organ function after burn injury was analyzed. METHODS A multicenter, randomized, single-blind, parallel controlled trial was conducted to evaluate the efficacy of glutamine in decreasing hypermetabolism after burn injury. Physiological and biochemical indexes, such as vital signs, metabolic hormones, metabolic rate, and organ damage, were recorded on the 7th and 14th days after treatment. RESULTS In total, 55 adult burn patients with a total burn surface area (TBSA) of 30-70% were included in this study and randomly divided into the burn control (B, 28 patients) and burn+glutamine (B+G, 27 patients) groups. Except for the glutamine administration, the groups did not differ in the other treatments and nutrition supplements. The levels of diamine oxidase (DAO), lactulose/mannitol (L/M), β2-microglobulin, lactate dehydrogenase (LDH), hydroxybutyrate dehydrogenase (HBD) and cardiac troponin l (cTnl) in the B+G group were significantly lower than those in the B group (p < 0.05 or 0.01). The levels of resting energy expenditure (REE), serum catecholamines, glucagon, lactate and Homeostasis model assessment (HOMA) in the B+G group were significantly lower than those in the B group (p < 0.05 or 0.01). No significant difference was found in the length of hospitalization or the mortality rate between the two groups (p > 0.05). CONCLUSIONS Glutamine moderately alleviates the hypermetabolic response and reduces organ damage after severe burns. Therefore, the early application of glutamine, which is effective and safe, should be used as an active intervention as early as possible.
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Affiliation(s)
- Zi En Wang
- Department of Burns, Union Hospital, Fujian Medical University, Fuzhou, China; Clinical Medical Research Center, Southwest Hospital, Third Military Medical University, Army Medical University, Chongqing, China
| | - Jian Jun Zheng
- Department of Burns, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Jin Bin Feng
- Department of Burn Surgery, No. 264 Hospital of PLA, Taiyuan, China
| | - Dan Wu
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University, Army Medical University, Chongqing, China
| | - Sen Su
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University, Army Medical University, Chongqing, China
| | - Yong Jun Yang
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University, Army Medical University, Chongqing, China
| | - Yan Wei
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University, Army Medical University, Chongqing, China
| | - Zhao Hong Chen
- Department of Burns, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xi Peng
- Department of Burns, Union Hospital, Fujian Medical University, Fuzhou, China; Clinical Medical Research Center, Southwest Hospital, Third Military Medical University, Army Medical University, Chongqing, China; Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University, Army Medical University, Chongqing, China; Shriners Burns Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Berger MM, Binz PA, Roux C, Charrière M, Scaletta C, Raffoul W, Applegate LA, Pantet O. Exudative glutamine losses contribute to high needs after burn injury. JPEN J Parenter Enteral Nutr 2021; 46:782-788. [PMID: 34288001 PMCID: PMC9292800 DOI: 10.1002/jpen.2227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Burnpatients characteristically have increased energy, glucose, and protein requirements. Glutamine supplementation is strongly recommended during early‐phase treatment and is associated with improved immunity, wound healing, and reduced mortality. This study evaluated if early burn exudative losses might contribute to higher supplementation needs. Methods Patients admitted to the burn intensive care unit (ICU) had exudate collection from tight bandages applied to arms or legs during the first week (exudate aliquot twice daily). Seven amino acids (alanine, arginine, cystEine, glutamine, leucine, lysine, and methionine) were quantified by liquid chromatography–mass spectrometry. Descriptive analysis of all results is provided as median and interquartile range or in value ranges. Results Eleven patients aged 19–77 years, presenting with burns on 18%–70% of the body surface, with a median simplified acute physiology score II of 33 (range, 16–56) were included during the study period. The highest amino acid losses were observed during the first 3 days with an important interpatient and intrapatient variability. Glutamine and alanine losses were highest, followed by leucine and lysine in all patients; amino acid exudate concentrations were in the range of normal plasma concentrations and were stable over time. Total glutamine losses were correlated to the burned surface (r2 = 0.552, P = .012), but not to enteral glutamine supplements. Conclusions The study shows significant exudative losses during early‐stage burn recovery and particularly for glutamine and alanine. Glutamine loss generally decreased with wound closure, the subsequent decline of exudation, and the evolving size of burn surfaces.
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Affiliation(s)
- Mette M Berger
- Service of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pierre-Alain Binz
- Clinical Chemistry Laboratory, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Clothilde Roux
- Clinical Chemistry Laboratory, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Mélanie Charrière
- Service of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Corinne Scaletta
- Unit of Regenerative Therapy, Service of Plastic, Reconstructive, and Hand Surgery, Department of Musculoskeletal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Wassim Raffoul
- Unit of Regenerative Therapy, Service of Plastic, Reconstructive, and Hand Surgery, Department of Musculoskeletal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Lee Ann Applegate
- Unit of Regenerative Therapy, Service of Plastic, Reconstructive, and Hand Surgery, Department of Musculoskeletal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Pantet
- Service of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Hu G, Yuan L, Peng Y, Luo G, Song H. Predictive Value of the Prognostic Nutrition Index for the Prognosis of Patients With Severe Burns Treated With the Meek Graft. J Burn Care Res 2021; 42:448-453. [PMID: 33022707 DOI: 10.1093/jbcr/iraa173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The Meek technique is currently a key method for treating wounds in severely burned patients. The survival rate of skin grafts is an important factor affecting the success rate of treatment. The purpose of this study was to investigate the effect of the preoperative prognostic nutritional index (PNI) on the survival rate of skin grafts in patients treated with the Meek technique in the early stage of severe burns. We retrospectively analyzed the data of severely burned patients who were treated at the burn center between January 2013 and December 2019 and met the inclusion criteria. The albumin (ALB) level and lymphocyte count obtained 1 day before the operation was used to calculate the preoperative PNI (PNI = serum ALB level [g/L] + 5 × total number of peripheral blood lymphocytes [×109/L]). According to the survival rates of skin grafts 14 days after the operation, patients with severe burns were divided into a group with good skin graft survival (survival rate ≥75%, abbreviated as group G) and a group with poor skin graft survival (survival rate <75%, abbreviated as group P). Receiver-operating characteristic (ROC) curves and univariate and multivariate analyses were used to evaluate the predictive value of the preoperative PNI for the prognosis of patients treated with the Meek technique. One hundred and twenty-one patients were enrolled in this study. Groups G (n = 66 cases) and P (n = 55 cases) did not have significant differences in age, sex, and body mass index (P > .05). The total burned surface area, burn index, platelet-to-lymphocyte ratio, preoperative platelet count, operative time, total protein, albumin level, globulin level, and PNI were the risk factors affecting the survival of Meek grafts. The burn index was an independent risk factor for poor skin graft survival (odds ratio [OR]: 1.049, 95% confidence interval [CI]: 1.020-1.079; P < .05). The preoperative PNI was a protective factor against poor skin graft survival (OR: 0.646, 95% CI: 0.547-0.761; P < .05). The ROC curve determined that the optimal cut-off value for the preoperative PNI was 34.98. There were 59 cases with PNI > 34.98 (the high PNI group) and 62 cases with PNI < 34.98 (the low PNI group). The survival rate of skin grafts in patients with a high PNI was generally significantly higher than that of patients with a low preoperative PNI (P < .05). Five (8.47%) patients in the high PNI group died, compared with 16 (25.8%) patients in the low PNI group. The difference in the mortality rate between the two groups was significant (P < .05). Preoperative PNI can be used as a predictor of the survival rate of skin grafts in patients treated with the Meek technique in the early stage of severe burns.
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Affiliation(s)
- Gaozhong Hu
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lili Yuan
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yizhi Peng
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Gaoxing Luo
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Huapei Song
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Zhang P, Wang W, Hu G, Yuan L, Ma S, Luo J, Song H, Huang Y, Xiang F. A Retrospective Study of Factors Influencing the Survival of Modified Meek Micrografting in Severe Burn Patients. J Burn Care Res 2021; 42:331-337. [PMID: 32915966 DOI: 10.1093/jbcr/iraa163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Modified Meek micrografting is a common method for treating severe burn patients. This study was to analyze the factors affecting the survival of modified Meek micrografting, thereby improving the survival rate of skin grafts. Eighty-three patients who underwent modified Meek micrografting were analyzed. According to the survival rate of skin graft after operation, the patients were divided into good skin survival group (GSSG, survival rate ≥ 70%, 47 cases) and poor skin survival group (PSSG, survival rate < 70%, 36 cases). The baseline data, surgical information, perioperative laboratory indicators, and prognosis of the patients were statistically analyzed. The univariate analysis and repeated measurement showed the burn severity, Meek skin graft area, duration of anesthesia, the postoperative sepsis shock, the mortality, the neutrophils percentage on the third day after surgery (NEU3), and the growth rate of neutrophils percentage from the first to third day after surgery (NEU3-1%) in the GSSG were significantly lower than those in the PSSG, whereas the perioperative average albumin levels and the perioperative average pre-albumin levels were higher. Receiver operating characteristic curve showed that the NEU3 had a good predictive value for the survival of skin slices. Maintaining perioperative albumin levels at a high level, controlling perioperative infection, and shortening the operation time as much as possible may improve the survival rate of modified Meek micrografting.
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Affiliation(s)
- Peng Zhang
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Wensheng Wang
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Gaozhong Hu
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lili Yuan
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Siyuan Ma
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jia Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Huapei Song
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yuesheng Huang
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Fei Xiang
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Żwierełło W, Styburski D, Maruszewska A, Piorun K, Skórka-Majewicz M, Czerwińska M, Maciejewska D, Baranowska-Bosiacka I, Krajewski A, Gutowska I. Bioelements in the treatment of burn injuries - The complex review of metabolism and supplementation (copper, selenium, zinc, iron, manganese, chromium and magnesium). J Trace Elem Med Biol 2020; 62:126616. [PMID: 32739827 DOI: 10.1016/j.jtemb.2020.126616] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
Appropriate nutrition is a key component of burn treatment and should be regarded as an integral part of the therapeutic process in burn patients. A nutritional intervention plan should not only allow for adequate quantities of energy and protein but also carefully consider the supply of macro- and micronutrients. As a result of the severe inflammatory response, oxidative stress, and hypermetabolic state, accompanied by often extensive exudation in burn patients, there is a considerable loss of macro- and micronutrients, including essential trace elements. This leads to certain complications, involving e.g. more frequent infections and impaired wound healing. Our current body of knowledge is still insufficient, and the studies carried out to date focus for the most part on the imbalances in trace elements, such as copper (Cu), selenium (Se), and zinc (Zn). Nevertheless, there are many other trace elements involved in immune functions, regulating gene expression or antioxidant defense, and many of those have not been properly investigated in a clinical setting. Due to the insufficient amount of unambiguous literature data and relatively few, often dated, studies carried out with small patient groups, further evaluation of macro- and microelements in burn patients seems indispensable, e.g. to bring up to date local nutritional protocols.
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Affiliation(s)
- Wojciech Żwierełło
- Department of Medical Chemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111 Szczecin, Poland
| | - Daniel Styburski
- Department of Medical Chemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111 Szczecin, Poland
| | - Agnieszka Maruszewska
- Institute of Biology, University of Szczecin, Felczaka 3c St, 71-412, Szczecin, Poland
| | - Krzysztof Piorun
- West Pomeranian Center of Treating Severe Burns and Plastic Sugery, Niechorska 27 Street, 72-300, Gryfice, Poland
| | - Marta Skórka-Majewicz
- Department of Medical Chemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111 Szczecin, Poland
| | - Maja Czerwińska
- Department of Human Nutrition and Metabolomic, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111, Szczecin, Poland
| | - Dominika Maciejewska
- Department of Human Nutrition and Metabolomic, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111, Szczecin, Poland
| | - Irena Baranowska-Bosiacka
- Department of Biochemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111, Szczecin, Poland
| | - Andrzej Krajewski
- West Pomeranian Center of Treating Severe Burns and Plastic Sugery, Niechorska 27 Street, 72-300, Gryfice, Poland
| | - Izabela Gutowska
- Department of Medical Chemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp 72street, 70-111 Szczecin, Poland.
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Khairiza R, Tanuwijaya LY, Najatullah. Nutrition problems in a severe burn patient with schizophrenia: a case report. Pan Afr Med J 2020; 37:257. [PMID: 33598072 PMCID: PMC7864282 DOI: 10.11604/pamj.2020.37.257.21269] [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: 12/19/2019] [Accepted: 10/20/2020] [Indexed: 11/19/2022] Open
Abstract
Hypermetabolic conditions with nutrition deficiencies are common in patients with extensive burns. Balanced nutrition status is required to achieve adequate wound healing. Mental disorder, which tended to make a patient uncooperative, complicates the management. We report the case of a 35-year-old man with schizophrenia who suffered full- and partial-thickness burns in approximately 38% of total body surface area due to attempted suicide. The patient was hospitalized for 66 days and underwent multiple surgeries. His body mass index (BMI) was continuously low. Tissue injuries provoked inflammatory responses that contributed to metabolic disarrangement, meanwhile the presence of psychiatric disorder complicated the means of nutrition assessment and therapy needed to compensate for the high nutrition demand during the treatment period. Nutrition support should be assessed and adjusted continuously.
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Affiliation(s)
- Rizka Khairiza
- Division of Plastic Reconstructive and Aesthetic Surgery, Dr. Kariadi Central General Hospital, Semarang, Central Java, Indonesia
| | - Lucretya Yeniwati Tanuwijaya
- Division of Plastic Reconstructive and Aesthetic Surgery, Dr. Kariadi Central General Hospital, Semarang, Central Java, Indonesia
| | - Najatullah
- Division of Plastic Reconstructive and Aesthetic Surgery, Dr. Kariadi Central General Hospital, Semarang, Central Java, Indonesia
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Yang YJ, Liu MM, Zhang Y, Wang ZE, Dan-Wu, Fan SJ, Wei Y, Xia L, Peng X. Effectiveness and mechanism study of glutamine on alleviating hypermetabolism in burned rats. Nutrition 2020; 79-80:110934. [PMID: 32847775 DOI: 10.1016/j.nut.2020.110934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/14/2020] [Accepted: 06/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study aimed to explore the effects of glutamine on hypermetabolic reactions in burned rats and its underlying mechanism. METHODS Fifty-five Sprague-Dawley rats were randomly divided into three groups, namely, the control (C), burned (B), and burned + glutamine (B + G) groups. Rats in the glutamine treatment group were supplemented with 1 g glutamine per kg body weight. Changes in body weight and resting energy expenditure in all groups were observed daily. Blood glucose and glucose tolerance level were measured on days 1, 3, 7, 10 and 14 after burn injury. On days 7 and 14 after injury, the rats were sacrificed, and the weight and protein content of the skeletal muscle were measured. Moreover, the level of glutamine, inflammatory mediator, nicotinamide adenine dinucleotide phosphate (NADPH), glutathione, and the activity of glutamine metabolic enzymes were measured. RESULTS The hypermetabolic reaction after burn injury was significantly inhibited by glutamine administration, and the range of variations in the resting energy expenditure and body weight indicators was narrowed remarkably (P < 0.05 or 0.01), whereas the weight and protein content of the skeletal muscle returned to normal (P < 0.05 or 0.01). Glutamine could increase glutaminase activity in various tissues, promote the utilization of glutamine, and appropriately reduce the degree of organ damage and inflammatory response (P < 0.05 or 0.01). Furthermore, glutamine could promote the synthesis of the reducing substances NADPH and glutathione (P < 0.05 or 0.01). CONCLUSIONS Glutamine administration effectively reduces hypermetabolic reactions by promoting NADPH synthesis, inhibiting oxidative stress, and improving glutamine utilization after burn injury.
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Affiliation(s)
- Yong-Jun Yang
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing China
| | - Man-Man Liu
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing China
| | - Yong Zhang
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing China
| | - Zi En Wang
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing China; Department of Burns, Union Hospital, Fujian Medical University, Fuzhou China
| | - Dan-Wu
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing China
| | - Shi-Jun Fan
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing China
| | - Yan Wei
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing China
| | - Lin Xia
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing China
| | - Xi Peng
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing China; Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing China; Department of Burns, Union Hospital, Fujian Medical University, Fuzhou China; Shriners Burns Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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11
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Boldeanu L, Boldeanu MV, Bogdan M, Meca AD, Coman CG, Buca BR, Tartau CG, Tartau LM. Immunological approaches and therapy in burns (Review). Exp Ther Med 2020; 20:2361-2367. [PMID: 32765715 PMCID: PMC7401720 DOI: 10.3892/etm.2020.8932] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022] Open
Abstract
Burns have become an important public health problem in the last two decades, with just over a quarter of a million deaths annually. Major burns are accompanied by a strong inflammatory response, which will most often lead to systemic response inflammatory syndrome, followed by sepsis and finally induce multiple organ failure. The main mechanism involved in wound healing after burns is the inflammatory process, characterized by the recruitment of myeloid and T cells and by the involvement of numerous cytokines, chemokines, complement fractions, as well as various growth factors. Inflammasomes, protein-based cytosolic complexes, activated during metabolic stress or infection, play a role in modulating and improving the defense capacity of the innate immune system. Nucleotide-binding domain and leucine-rich repeat protein 3 (NLRP3) inflammasome has been studied predominantly and several hypotheses have been issued. Restoring the balance between the pro-inflammatory response and the anti-inflammatory activity is the key element to effective therapy in burns. Severe burns require nutritional support and pharmacotherapy not only for burn area but for different pathological complications of burn injury. In-depth research is required to find new ways to modulate the defense capacity, to prevent the complications of abnormal immune response and to treat burn injuries efficiently.
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Affiliation(s)
- Lidia Boldeanu
- Department of Microbiology, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Mihail Virgil Boldeanu
- Department of Immunology, University of Medicine and Pharmacy, 200349 Craiova, Romania.,Department of Medico Science SRL, Stem Cell Bank Unit, 200690 Craiova, Romania
| | - Maria Bogdan
- Department of Pharmacology, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Andreea Daniela Meca
- Department of Pharmacology, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Corneliu George Coman
- Department of Pharmacology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Beatrice Rozalina Buca
- Department of Pharmacology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cosmin Gabriel Tartau
- Department of Pharmacology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Liliana Mititelu Tartau
- Department of Pharmacology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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12
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Abstract
PURPOSE OF REVIEW Glutamine (GLN) is a versatile amino acid, long believed to have important implications in ICU and surgical patients. An extensive body of data examining GLN supplementation of TPN demonstrated a consistent signal of improved outcomes. However, recently signals of risk have come from two large-scale multicenter trials evaluating GLN (and other nutrients) at high dose and as primary pharmaconutrients, not as supplementation to complete nutrition. These trials indicate a risk of increased mortality when GLN is given to patients in shock, renal failure, and early in acute phase of critical care. RECENT FINDINGS Recent literature continues to confirm that low and high admission GLN levels are associated with increased ICU mortality and adverse outcomes. Further, a recent meta-analysis examined trials utilizing GLN-supplemented TPN in stabile ICU patients consistent with current clinical guidelines. This analysis showed GLN supplementation of TPN led to reduced infections, LOS and hospital mortality. SUMMARY Three recent meta-analyses have confirmed traditional GLN-supplemented (or 'GLN-Complemented' - providing GLN for completeness of amino acid content) TPN is safe, reduces mortality and improves outcome in surgical and ICU patients. Patients in need of TPN, burns, trauma or malignancies should continue to benefit from supplemental GLN, administered either intravenously at less than 0.35 g/kg/day or enterally at less than 0.5 g/kg/day. Further, a large trial of EN GLN supplementation in burns is ongoing. Thus, when used per guideline recommendations, the GLN story is likely still relevant to ICU outcomes and research.
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13
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Rousseau AF, Verbrugge AM, Fadeur M, Struvay A, Lefort H. [Nutritional aspects of the management of the severely burned patient]. REVUE DE L'INFIRMIÈRE 2020; 68:28-29. [PMID: 31870475 DOI: 10.1016/j.revinf.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The nutrition of the severely burned patient is one of the pillars of his or her care, from the first few hours after the accident to rehabilitation. When properly conducted, there is a recognized beneficial effect on morbidity and even mortality.
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Affiliation(s)
- Anne-Françoise Rousseau
- Centre des brûlés et équipe nutritionnelle multidisciplinaire, centre hospitalier universitaire de Liège, avenue de l'hôpital, 1 4000 Liège, Belgique.
| | - Anne-Marie Verbrugge
- Centre des brûlés et équipe nutritionnelle multidisciplinaire, centre hospitalier universitaire de Liège, avenue de l'hôpital, 1 4000 Liège, Belgique
| | - Marjorie Fadeur
- Centre des brûlés et équipe nutritionnelle multidisciplinaire, centre hospitalier universitaire de Liège, avenue de l'hôpital, 1 4000 Liège, Belgique
| | - Alexandre Struvay
- Centre des brûlés et équipe nutritionnelle multidisciplinaire, centre hospitalier universitaire de Liège, avenue de l'hôpital, 1 4000 Liège, Belgique
| | - Hugues Lefort
- Structure des urgences, hôpital d'instruction des armées Legouest,27 avenue des Plantieres 57077 Metz cedex 3, France
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14
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Efficacy of CMC supplementary burns feed (SBF) in burns patients: A retrospective study. BURNS OPEN 2020. [DOI: 10.1016/j.burnso.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Coutris N, Gawaziuk JP, Cristall N, Logsetty S. Interrupted Nutrition Support in Patients With Burn Injuries: A Single-Centre Observational Study. Plast Surg (Oakv) 2019; 27:334-339. [PMID: 31763334 DOI: 10.1177/2292550319880917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Enteral nutrition (EN) is essential to meet the increased metabolic requirements of burn-injured patients. However, feeds are often suspended for care. This study examines the interruptions in EN (IEN). Objective To determine the frequency and duration of IEN and whether these interruptions are predictable or unpredictable. Design This retrospective chart review of 27 adult burn patients examined age, sex, body mass index, percentage of total body surface area, length of hospital stay, predicted energy requirements from equations and indirect calorimetry, EN start time, time EN reached goal rate, and interruptions to EN. Results Predictable interruptions accounted for 74.5% (frequency) and 81.6% (duration) of total interruptions. The most frequent and time-consuming interruptions were perioperative period, extubation, and tests/procedures (predictable) versus high gastric residual volume, emesis/nausea, and feeding tube displacement (unpredictable). Conclusions Most IEN were due to predictable events. Based on these findings, compensating for predictable interruptions to meet nutritional requirements in burn patients is recommended.
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Affiliation(s)
| | - Justin P Gawaziuk
- Manitoba Firefighter's Burn Program, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Nora Cristall
- Manitoba Firefighter's Burn Program, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Sarvesh Logsetty
- Manitoba Firefighter's Burn Program, Health Sciences Centre, Winnipeg, Manitoba, Canada.,Departments of Surgery and Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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16
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Abstract
Nutritional support is seen as a vital component in the battle to attenuate the extreme hypermetabolic response experienced by patients suffering from large thermal injuries. Protein catabolism precipitating protein malnutrition places patients at greater risk of wound infection and sepsis due to delayed wound healing. Underfeeding, aggressive feeding, feeding routes, timing of initiation of feeding and tight insulin control have all been explored extensively in the quest to understand what nutritional treatment will best attenuate the hypermetabolic response. Despite this it is suggested that the majority of patients with large thermal injuries do not receive adequate nutritional support immediately post injury. Nurses have a pivotal role to play in ensuring that thermal injury patients receive appropriate nutritional support based on the best available evidence.
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Affiliation(s)
- Christina Price
- Wound Care Nurse Specialist/Staff Trainer, Bethesda General Hospital, Serukam, Singkawang, West Borneo, Indonesia
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17
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Abstract
Burn injury is the most devastating of survivable injuries and is a worldwide public health crisis. Burn injury is among the most severe metabolic stresses a patient can sustain. A major burn leads to an inflammatory response and catabolism that, when compounded by burn wound nutrient losses, can lead to severe nutrition losses and deficiencies. These losses can impair immune function and wound healing and place burn patients at high risk for organ injury and mortality. Experimental data indicate glutamine (GLN) is well positioned mechanistically, perhaps above and beyond in any other intensive care unit setting, to improve outcome in burn-injured patients. Initial clinical trial data have also shown a consistent signal of reduced mortality and reduced hospital length of stay in burn-injured subjects, without signals of clinical risk. A number of GLN clinical trials demonstrate significant reductions of gram-negative bacteremia in burn injury, perhaps via maintenance of the gut barrier or gut immune function. Current societal recommendations continue to suggest the use of GLN in burn injury. The promising clinical data in burn-injured patients, with no signals of harm, have warranted study of GLN in the definitive RE-ENERGIZE trial, which is now ongoing.
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Affiliation(s)
- Paul E Wischmeyer
- Department of Anesthesiology and Duke Clinical Research Institute, Duke University Hospital, Durham, North Carolina, USA
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18
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Bang YK, Park MK, Ju YS, Cho KY. Clinical significance of nutritional risk screening tool for hospitalised children with acute burn injuries: a cross-sectional study. J Hum Nutr Diet 2017; 31:370-378. [PMID: 28948659 DOI: 10.1111/jhn.12518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We assessed the nutritional risks among children hospitalised with acute burn injuries and their associated clinical outcomes using three nutritional risk screening (NRS) tools: Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGKIDS ), Pediatric Yorkhill Malnutrition Score (PYMS) and Screening Tool for the Assessment for Malnutrition in Pediatrics (STAMP). METHODS This prospective cross-sectional study was conducted from October 2015 to November 2016, in a regional burn centre. Patients were screened by two independent observers, using the three NRS tools. RESULTS A total of 100 children aged 3 months to 16.5 years were included. STRONGKIDS identified 16% of patients as having high risk, with being identified 45% by PYMS and 44% by STAMP. After adjustment for confounding factors in multivariate regression analysis, patients in the high-risk group had significantly longer median (SD) lengths of stay [medium versus high risk: STRONGKIDS , 9.5 (6.6) versus 15.0 (24.2) days; PYMS, 8.5 (4.4) versus 13.0 (16.1) days; STAMP, 9.0 (5.7) versus 11.0 (17.4) days] and greater median (SD) weight loss [medium versus high risk: STRONGKIDS, 0.15 (0.8) versus -0.35 (0.8) kg; STAMP, 0.5 (0.7) versus 0 (0.1) kg] than patients in the medium-risk group (P < 0.05). The strengths of agreement in the nutritional risk classification between the two observers were good (κ for STRONGKIDS = 0.61; PYMS = 0.79; STAMP = 0.75) (P < 0.01). CONCLUSIONS The STRONGKIDS , PYMS and STAMP tools could be useful and practical for determining which hospitalised children with acute burn injuries will need additional nutritional intervention.
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Affiliation(s)
- Y K Bang
- Departments of Pediatrics, KEPCO Medical Center, Seoul, Korea
| | - M K Park
- Departments of Pediatrics, KEPCO Medical Center, Seoul, Korea
| | - Y S Ju
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, Korea
| | - K Y Cho
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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19
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Gut microbiota trajectory in patients with severe burn: A time series study. J Crit Care 2017; 42:310-316. [PMID: 28822895 DOI: 10.1016/j.jcrc.2017.08.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/05/2017] [Accepted: 08/11/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE This time series experiments aimed to investigate the dynamic change of gut microbiomes after severe burn and its association with enteral nutrition (EN). MATERIALS AND METHODS Seven severely burned patients who suffered from a severe metal dust explosion injury were recruited in this study. The dynamic changes of gut microbiome of fecal samples at six time points (1-3days, 2, 3, 4, 5 and 6weeks after severe burn) were detected using 16S ribosomal RNA pyrosequencing technology. RESULTS Following the post-burn temporal order, gut microbiota dysbiosis was detected in the gut microbiome after severe burn, then it was gradually resolved. The bio-diversity of gut bacteria was initially decreased, and then returned to normal level. In addition, at the early stage (from 2 to 4weeks), the majority of those patients' gut microbiome were opportunistic pathogen genus, Enterococcus and Escherichia; while at the end of this study, the majority was a beneficial genus, Bacteroides. EN can promote the recovery of gut microbiota, especially in EN well-tolerated patients. CONCLUSIONS Severe burn injury can cause a dramatic dysbiosis of gut microbiota. A trend of enriched beneficial bacteria and diminished opportunistic pathogen bacteria may serve as prognosis microbiome biomarkers of severe burn patients.
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