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Gökdemir BN, Çekmen N. Vasoplegic Syndrome and Anaesthesia: A Narrative Review. Turk J Anaesthesiol Reanim 2023; 51:280-289. [PMID: 37587654 PMCID: PMC10440482 DOI: 10.4274/tjar.2023.221093] [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: 10/06/2022] [Accepted: 02/23/2023] [Indexed: 08/18/2023] Open
Abstract
Vasoplegic syndrome (VS) is defined as low systemic vascular resistance, normal or high cardiac output, and resistant hypotension unresponsive to vasopressor agents and intravenous volume. VS is a frequently encountered complication in cardiovascular and transplantation surgery, burns, trauma, pancreatitis, and sepsis. The basis of the pathophysiology is associated with an imbalance of vasodilator and vasoconstrictive structure in vascular smooth muscle cells and is highly complex. The pathogenesis of VS has several mechanisms, including overproduction of iNO, stimulation of ATP-dependent K+ channels and NF-κB, and vasopressin receptor 1A (V1A-receptor) down-regulation. Available treatments involve volume and inotropes administration, vasopressin, methylene blue, hydroxocobalamin, Ca++, vitamin C, and thiamine, and should also restore vascular tone and improve vasoplegia. Other treatments could include angiotensin II, corticosteroids, NF-κB inhibitor, ATP-dependent K+ channel blocker, indigo carmine, and hyperbaric oxygen therapy. Despite modern advances in treatment, the mortality rate is still 30-50%. It is challenging for an anaesthesiologist to consider this syndrome's diagnosis and manage its treatment. Our review aims to review the diagnosis, predisposing factors, pathophysiology, treatment, and anaesthesia approach of VS during anaesthesia and to suggest a treatment algorithm.
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Affiliation(s)
- Begüm Nemika Gökdemir
- Department of Anaesthesiology and Reanimation, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Nedim Çekmen
- Department of Anaesthesiology and Reanimation, Başkent University Faculty of Medicine, Ankara, Turkey
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2
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Emergency Care for Burn Patients-A Single-Center Report. J Pers Med 2023; 13:jpm13020238. [PMID: 36836472 PMCID: PMC9959911 DOI: 10.3390/jpm13020238] [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: 12/26/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
Burns, one of the main public health problems, lead to significant mortality and morbidity. Epidemiological studies regarding burn patients in Romania are scarce. The aim of this study is to identify the burn etiology, demographics, clinical characteristics, and outcomes in patients requiring treatment in a regional burn unit. DESIGN We performed a retrospective observational study of 2021. PATIENTS All patients admitted to our six-bed intensive care unit (ICU) were included. INTERVENTIONS The following data were collected for further analysis: demographics, burn pattern (etiology, size, depth, affected body region), type of ventilation, ABSI (Abbreviated Burn Severity Index) score, comorbidities, bioumoral parameters, and hospitalization days. RESULTS There were 93 burned patients included in our study that were divided into two groups: alive patients' group (63.4%) and deceased patients' group (36.6%). The mean age was 55.80 ± 17.16 (SD). There were 65.6% male patients, and 39.8% of the patients were admitted by transfer from another hospital. Further, 59 patients presented third-degree burns, from which 32.3% died. Burns affecting >37% of the total body surface area (TBSA) were noticed in 30 patients. The most vulnerable regions of the body were the trunk (p = 0.003), the legs (p = 0.004), the neck (p = 0.011), and the arms (p = 0.020). Inhalation injury was found in 60.2% of the patients. The risk of death in a patient with an ABSI score > 9 points was 72 times higher. Comorbidities were present in 44.1% of the patients. We observed a median LOS (length of stay) of 23 days and an ICU-LOS of 11 days. Logistic regression analysis showed that admission protein, creatinkinase, and leukocytes were independent risk factors for mortality. The general mortality rate was 36.6%. CONCLUSION A thermal factor was responsible for the vast majority of burns, 94.6% of cases being accidents. Extensive and full-thickness burns, burns affecting the arms, inhalation injuries, the need for mechanical ventilation, and a high ABSI score represent important risk factors for mortality. Considering the results, it appears that prompt correction of protein, creatinkinase, and leukocytes levels may contribute to improvement in severe burn patients' outcomes.
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3
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Knoedler S, Matar DY, Knoedler L, Obed D, Haug V, Gorski SM, Kim BS, Kauke-Navarro M, Kneser U, Panayi AC, Orgill DP, Hundeshagen G. Association of age with perioperative morbidity among patients undergoing surgical management of minor burns. Front Surg 2023; 10:1131293. [PMID: 36923377 PMCID: PMC10008887 DOI: 10.3389/fsurg.2023.1131293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/13/2023] [Indexed: 03/01/2023] Open
Abstract
Introduction Burn injuries are associated with significant morbidity, often necessitating surgical management. Older patients are more prone to burns and more vulnerable to complications following major burns. While the relationship between senescence and major burns has already been thoroughly investigated, the role of age in minor burns remains unclear. To better understand differences between elderly and younger patients with predominantly minor burns, we analyzed a multi-institutional database. Methods We reviewed the 2008-2020 ACS-NSQIP database to identify patients who had suffered burns according to ICD coding and underwent initial burn surgery. Results We found 460 patients, of which 283 (62%) were male and 177 (38%) were female. The mean age of the study cohort was 46 ± 17 years, with nearly one-fourth (n = 108; 23%) of all patients being aged ≥60 years. While the majority (n = 293; 64%) suffered from third-degree burns, 22% (n = 99) and 15% (n = 68) were diagnosed with second-degree burns and unspecified burns, respectively. An average operation time of 46 min, a low mortality rate of 0.2% (n = 1), a short mean length of hospital stay (1 day), and an equal distribution of in- and outpatient care (51%, n = 234 and 49%, n = 226, respectively) indicated that the vast majority of patients suffered from minor burns. Patients aged ≥60 years showed a significantly prolonged length of hospital stay (p<0.0001) and were significantly more prone to non-home discharge (p<0.0001). In univariate analysis, advanced age was found to be a predictor of surgical complications (p = 0.001) and medical complications (p = 0.0007). Elevated levels of blood urea nitrogen (p>0.0001), creatinine (p>0.0001), white blood cell count (p=0.02), partial thromboplastin time (p = 0.004), and lower levels of albumin (p = 0.0009) and hematocrit (p>0.0001) were identified as risk factors for the occurrence of any complication. Further, complications were more frequent among patients with lower body burns. Discussion In conclusion, patients ≥60 years undergoing surgery for predominantly minor burns experienced significantly more complications. Minor lower body burns correlated with worse outcomes and a higher incidence of adverse events. Decreased levels of serum albumin and hematocrit and elevated values of blood urea nitrogen, creatinine, white blood count, and partial thromboplastin time were identified as predictive risk factors for complications.
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Affiliation(s)
- Samuel Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.,Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Dany Y Matar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.,Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Doha Obed
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Valentin Haug
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Sabina M Gorski
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Martin Kauke-Navarro
- Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Adriana C Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Dennis P Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Gabriel Hundeshagen
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
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Abstract
ABSTRACT Management of the metabolic responses to severe burn injury is recognized as a fundamental part of burn care. Definition of burn hypermetabolism is being refined to subcellular and genomic levels, and treatment concepts are need to be refined into increasingly sophisticated strategies.
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Affiliation(s)
- David Herndon
- From the Joseph M. Still Research Foundation, Inc., Augusta, GA
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5
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Biswas A, Dalal K, Sawon RA, Mayaboti CA, Mashreky SR. Emergency management for severe burn (EMSB) course for the nurses in Bangladesh: opportunity and way forward. Heliyon 2022; 8:e09156. [PMID: 35846460 PMCID: PMC9280581 DOI: 10.1016/j.heliyon.2022.e09156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 08/03/2021] [Accepted: 03/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Methodology Results Conclusions
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6
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Abstract
OBJECTIVE The burden of the management of problematic skin wounds characterised by a compromised skin barrier is growing rapidly. Almost six million patients are affected in the US alone, with an estimated market of $25 billion annually. There is an urgent requirement for efficient mechanism-based treatments and more efficacious drug delivery systems. Novel strategies are needed for faster healing by reducing infection, moisturising the wound, stimulating the healing mechanisms, speeding up wound closure and reducing scar formation. METHODS A systematic review of qualitative studies was conducted on the recent perspectives of nanotechnology in burn wounds management. Pubmed, Scopus, EMBASE, CINAHL and PsychINFO databases were all systematically searched. Authors independently rated the reporting of the qualitative studies included. A comprehensive literature search was conducted covering various resources up to 2018-2019. Traditional techniques aim to simply cover the wound without playing any active role in wound healing. However, nanotechnology-based solutions are being used to create multipurpose biomaterials, not only for regeneration and repair, but also for on-demand delivery of specific molecules. The chronic nature and associated complications of nonhealing wounds have led to the emergence of nanotechnology-based therapies that aim at facilitating the healing process and ultimately repairing the injured tissue. CONCLUSION Nanotechnology-based therapy is in the forefront of next-generation therapy that is able to advance wound healing of hard-to-heal wounds. In this review, we will highlight the developed nanotechnology-based therapeutic agents and assess the viability and efficacy of each treatment. Herein we will explore the unmet needs and future directions of current technologies, while discussing promising strategies that can advance the wound-healing field.
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Affiliation(s)
- Ruan Na
- Orthopedics Department, Affiliated Tongji Hospital of Huazhong University of Science and Technology, Wuhan City, Hubei Province, 430030, China
| | - Tian Wei
- Department of Biomedical Engineering
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7
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Moinuddin K, Alanazi DS, Alsomali BA, Alotaibi M, Parameaswari PJ, Ali S. Prescription Pattern of Empirical Antibiotic Therapy in the Burn Unit of a Tertiary Care Setting in the Kingdom of Saudi Arabia. J Pharm Bioallied Sci 2021; 13:188-192. [PMID: 34349478 PMCID: PMC8291108 DOI: 10.4103/jpbs.jpbs_478_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/12/2020] [Accepted: 09/30/2020] [Indexed: 11/24/2022] Open
Abstract
Background: It is crucial to follow rational prescribing practices while prescribing antibiotics for burn patients, thus leading to better patient outcomes. The objective of this study was to assess the initiation of empirical antibiotics in the burn unit. Methods: A prospective cross-sectional study was conducted in a large tertiary care setting of the Kingdom of Saudi Arabia between August 2016 and December 2018. Results: A total of 102 hospitalized burn patients were included in this study, of whom 84 (82.4%) were males. Burns were classified as first degree, second degree, third degree, or fourth degree depending on their severity and extent of penetration into the skin. The majority (81.3%) of the patients suffered from flame burn, followed by scald (9.85), chemical (6.9%), and electrical (2%) types of burns. Broad-spectrum antibiotic such as piperacillin/tazobactam (40.57%) was the most common empirically prescribed antibiotic. In 35 patients (34.3%), there was a change in antibiotic after culture findings. Conclusion: This study demonstrated that 40% of antibiotic therapy decisions followed the recommended clinical guidelines. This study also found that Gram-negative microorganisms such as Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus were ubiquitous in our burn unit. The study results will facilitate to develop antibiogram for our study setting, thus reducing antibiotic resistance. Further studies are needed to explore the extent and consequences of irrational antibiotic prescriptions in critically ill burn patients.
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Affiliation(s)
- Khaja Moinuddin
- Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Deemah Sattam Alanazi
- Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Maram Alotaibi
- Pharmaceutical Care Department, King Abdul Aziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | - Sheraz Ali
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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8
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Glas GJ, Horn J, Hollmann MW, Preckel B, Colpaert K, Malbrain M, Neto AS, Asehnoune K, de Abreu MG, Martin-Loeches I, Pelosi P, Sjöberg F, Binnekade JM, Cleffken B, Juffermans NP, Knape P, Loef BG, Mackie DP, Enkhbaatar P, Depetris N, Perner A, Herrero E, Cachafeiro L, Jeschke M, Lipman J, Legrand M, Horter J, Lavrentieva A, Kazemi A, Guttormsen AB, Huss F, Kol M, Wong H, Starr T, De Crop L, de Oliveira Filho W, Manoel Silva Junior J, Grion CMC, Burnett M, Mondrup F, Ravat F, Fontaine M, Floch RL, Jeanne M, Bacus M, Chaussard M, Lehnhardt M, Mikhail BD, Gille J, Sharkey A, Trommel N, Reidinga AC, Vieleers N, Tilsley A, Onarheim H, Bouza MT, Agrifoglio A, Fredén F, Palmieri T, Painting LE, Schultz MJ. Ventilation practices in burn patients—an international prospective observational cohort study. BURNS & TRAUMA 2021; 9:tkab034. [PMID: 34926707 PMCID: PMC8676707 DOI: 10.1093/burnst/tkab034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/14/2021] [Accepted: 08/26/2021] [Indexed: 11/14/2022]
Abstract
Abstract
Background
It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it. This study aimed to determine ventilation practices in burn intensive care units (ICUs) and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28 (VFD-28).
Methods
This is an international prospective observational cohort study including adult burn patients requiring mechanical ventilation. Low tidal volume (VT) was defined as VT ≤ 8 mL/kg predicted body weight (PBW). Levels of positive end-expiratory pressure (PEEP) and maximum airway pressures were collected. The association between VT and VFD-28 was analyzed using a competing risk model. Ventilation settings were presented for all patients, focusing on the first day of ventilation. We also compared ventilation settings between patients with and without inhalation trauma.
Results
A total of 160 patients from 28 ICUs in 16 countries were included. Low VT was used in 74% of patients, median VT size was 7.3 [interquartile range (IQR) 6.2–8.3] mL/kg PBW and did not differ between patients with and without inhalation trauma (p = 0.58). Median VFD-28 was 17 (IQR 0–26), without a difference between ventilation with low or high VT (p = 0.98). All patients were ventilated with PEEP levels ≥5 cmH2O; 80% of patients had maximum airway pressures <30 cmH2O.
Conclusion
In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients, irrespective of the presence of inhalation trauma. Use of low VT was not associated with a reduction in VFD-28.
Trial registration
Clinicaltrials.gov NCT02312869. Date of registration: 9 December 2014.
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Affiliation(s)
- Gerie J Glas
- Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Janneke Horn
- Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Markus W Hollmann
- Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Benedikt Preckel
- Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Kirsten Colpaert
- Department of Anaesthesia and Intensive Therapy Medical University of Lublin Aleje Racklawickie 1 – 20-059 Lublin – Poland
| | - Manu Malbrain
- AZ JAN PALFIJN GENT Watersportlaan 5 – 9000 Gent – Belgium
- Department of Anaesthesia and Intensive Therapy Medical University of Lublin Aleje Racklawickie 1 – 20-059 Lublin – Poland
| | - Ary Serpa Neto
- ABC Medical School, São Paulo, Bangú, SP 5001, Brazil
- Australian and New Zealand Intensive Care Research Centre. Monash University, Melbourne, VIC 3004, Australia
- GH St-Louis- Lariboisière, APHP, Paris 75010, France
| | - Karim Asehnoune
- Service d'Anesthésie Réanimation Chirurgicale, Nantes 44093, France
| | | | | | | | - Folke Sjöberg
- Linköping University Hospital, Linköping 581 85, Sweden
| | - Jan M Binnekade
- Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | | | - Nicole P Juffermans
- Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
| | - Paul Knape
- Red Cross Hospital, Beverwijk, LE 1942, The Netherlands
| | - Bert G Loef
- Martini Hospital, Groningen, NT 9728, The Netherlands
| | | | | | | | | | - Eva Herrero
- La Paz University Hospital, Madrid 28046, Spain
| | | | - Marc Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto M4N 3M5, Canada
| | - Jeffrey Lipman
- Royal Brisbane and Women’s Hospital, Queensland University, Herston, QLD 4029, Australia
| | - Matthieu Legrand
- GH St-Louis- Lariboisière, APHP, Paris 75010, France
- Hopital Roger Salengro, CHRU Lille, Lille 59037, France
| | | | | | - Alex Kazemi
- Middlemore Hospital, Otahuhu, Auckland 2025, New Zealand
| | | | | | - Mark Kol
- Concord Repatriation General Hospital NSW, University of Sydney, Concord 2139, Australia
| | - Helen Wong
- Concord Repatriation General Hospital NSW, University of Sydney, Concord 2139, Australia
| | - Therese Starr
- Royal Brisbane and Women’s Hospital, Queensland University, Herston, QLD 4029, Australia
| | - Luc De Crop
- Department of Anaesthesia and Intensive Therapy Medical University of Lublin Aleje Racklawickie 1 – 20-059 Lublin – Poland
| | | | | | | | | | | | - Francois Ravat
- Sunnybrook Health Sciences Centre, Toronto M4N 3M5, Canada
| | | | | | - Mathieu Jeanne
- CHU Nantes Service dánesthesie reanimation chirugicale, Nantes 44093, France
| | - Morgane Bacus
- CHU Nantes Service dánesthesie reanimation chirugicale, Nantes 44093, France
| | | | | | | | - Jochen Gille
- BG University Hospital Bergmannsheil, Bochum 44789, Germany
| | - Aidan Sharkey
- St James University Hospital, Dublin D08 NHY1, Ireland
| | | | | | | | - Anna Tilsley
- Middlemore Hospital, Otahuhu, Auckland 2025, New Zealand
| | | | | | | | - Filip Fredén
- Uppsala University Hospital, Uppsala 751 85, Sweden
| | | | | | - Marcus J Schultz
- Academic Medical Center, University of Amsterdam, Amsterdam, AZ 1105, The Netherlands
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Huang YZ, Lu GZ, Zhao HS, Liu LJ, Jin J, Wu YF, Wu J, Zhao FL, Liu N, Liu WM, Liu L, Zhu TJ, Chen EZ, Gu Q, Ye HW, Xi XM, Du B, Yi Y, Qiu HB. Clinical features and mortality-related factors of extensive burns among young adults: the Kunshan disaster experience. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1053. [PMID: 33145272 PMCID: PMC7575965 DOI: 10.21037/atm-20-288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background The aim of the study was to identify the clinical features and the factors associated with burn induced mortality among young adults after exposure to indoor explosion and fire. Methods This is an observational study which included burn patients who were admitted to eighteen ICUs after a fire disaster. Epidemiologic and clinical characteristics, as well as therapy were recorded. The primary outcome was 90-day mortality. The mortality-related factors were also analyzed. Results There were 167 burn patients enrolled in the study, the median age was 38 years, 62 (37.1%) patients died within 90 days. Seventy-one percent of patients had a burn size ≥90% TBSA, and 73.7% of patients had a full-thickness burn area above 50% TBSA. The survivors had lower Baux scores, and received earlier escharectomy and autologous skin grafts. The 50% mortality rates (LA50s) for burn size and full-thickness burn area were 95.8% and 88.6% TBSA, respectively. The multivariate analysis showed that full-thickness burn area over 50% TBSA and residual burned surface area (RBSA)/TBSA at 28 days were strong predictors of mortality among burn patients (odds ratio 2.55; 95% CI, 1.01 to 6.44, P=0.047; odds ratio 1.07; 95% CI, 1.04 to 1.09, P<0.001). The ROC curve-based cut-off values of RBSA/TBSA at 28 days for predicting 90-day mortality were 62.5%. Conclusions Burn size and full-thickness burn area were the main risk factors for poor outcome in patients with extensive burns. Earlier escharectomy and autologous skin grafts may improve outcomes.
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Affiliation(s)
- Ying-Zi Huang
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Guo-Zhong Lu
- Department of Burn, Burn Intensive Care Unit, Wuxi Third People's Hospital, Wuxi, China
| | - Hong-Sheng Zhao
- Department of Critical Care Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Li-Jun Liu
- Department of Emergency and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Jin
- Department of Critical Care Medicine, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun-Fu Wu
- Department of Critical Care Medicine, Suzhou Municipal Hospital, Suzhou, China
| | - Jian Wu
- Department of Critical Care Medicine, North district of Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Fu-Li Zhao
- Department of Critical Care Medicine, Suzhou Municipal Hospital, Suzhou, China
| | - Ning Liu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Suzhow University, Changzhou 1st People's Hospital, Changzhou, China
| | - Wen-Ming Liu
- Department of Critical Care Medicine, Changzhou 2nd People's Hospital, Nanjing Medical University, Changzhou, China
| | - Long Liu
- Department of Critical Care Medicine, Kunshan People's Hospital, Suzhou, China
| | - Tuan-Jie Zhu
- Department of Critical Care Medicine, Su Zhu Kowloon Hosipital, Shanghai Jiaotong University Medical School, Shanghai, China
| | - Er-Zhen Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qin Gu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Nanjing, China
| | - Hong-Wei Ye
- Department of Critical Care Medicine, Changshu No.1 People's Hospital, Suzhou, China
| | - Xiu-Ming Xi
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Yi
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hai-Bo Qiu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Nebulized Heparin in Burn Patients with Inhalation Trauma-Safety and Feasibility. J Clin Med 2020; 9:jcm9040894. [PMID: 32218127 PMCID: PMC7230289 DOI: 10.3390/jcm9040894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Pulmonary hypercoagulopathy is intrinsic to inhalation trauma. Nebulized heparin could theoretically be beneficial in patients with inhalation injury, but current data are conflicting. We aimed to investigate the safety, feasibility, and effectiveness of nebulized heparin. Methods: International multicenter, double-blind, placebo-controlled randomized clinical trial in specialized burn care centers. Adult patients with inhalation trauma received nebulizations of unfractionated heparin (25,000 international unit (IU), 5 mL) or placebo (0.9% NaCl, 5 mL) every four hours for 14 days or until extubation. The primary outcome was the number of ventilator-free days at day 28 post-admission. Here, we report on the secondary outcomes related to safety and feasibility. Results: The study was prematurely stopped after inclusion of 13 patients (heparin N = 7, placebo N = 6) due to low recruitment and high costs associated with the trial medication. Therefore, no analyses on effectiveness were performed. In the heparin group, serious respiratory problems occurred due to saturation of the expiratory filter following nebulizations. In total, 129 out of 427 scheduled nebulizations were withheld in the heparin group (in 3 patients) and 45 out of 299 scheduled nebulizations were withheld in the placebo group (in 2 patients). Blood-stained sputum or expected increased bleeding risks were the most frequent reasons to withhold nebulizations. Conclusion: In this prematurely stopped trial, we encountered important safety and feasibility issues related to frequent heparin nebulizations in burn patients with inhalation trauma. This should be taken into account when heparin nebulizations are considered in these patients.
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11
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Sikhosana ML, Salloo A, Birkhead M, McCarthy K. Atypical presentation of herpes simplex virus type 1 infection in paediatric burns patients in a large tertiary hospital, South Africa. Afr J Lab Med 2019; 8:916. [PMID: 31745459 PMCID: PMC6852610 DOI: 10.4102/ajlm.v8i1.916] [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: 10/03/2018] [Accepted: 09/03/2019] [Indexed: 11/12/2022] Open
Abstract
Introduction Herpes simplex virus has been reported in the literature to commonly complicate burn wounds. However, there is paucity of such data in the South African setting. Case presentation Eight paediatric burns patients with ages ranging between 10 months and 5 years presented with a febrile maculopapular rash illness in a paediatric ward of a large South African tertiary hospital. The rash became vesicular in three cases, involving the limbs and face. Varicella was suspected. Management and outcome Medical records of suspected cases were reviewed. Blood, vesicular fluid and scab samples were collected. Electron microscopy of vesicular fluid revealed herpes virus particles. Laboratory testing confirmed herpes simplex virus type 1. Conclusion Herpes simplex virus type 1 infection can present atypically in burns patients.
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Affiliation(s)
- Mpho L Sikhosana
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Division of National Health Laboratory Services, Johannesburg, South Africa
| | - Asma Salloo
- Department of Critical Care, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa.,Department of Critical Care, University of Witwatersrand, Johannesburg, South Africa
| | - Monica Birkhead
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Division of National Health Laboratory Services, Johannesburg, South Africa
| | - Kerrigan McCarthy
- Division for Public Health Surveillance and Response, National Institute for Communicable Diseases, Division of National Health Laboratory Services, Johannesburg, South Africa
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12
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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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13
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Abstract
A major burn is a severe injury with a global impact. Our system of medical evacuation has led to the survival of many severely injured service members. Burn rehabilitation is a complex and dynamic process and will not be linear. Recovery requires a comprehensive, interdisciplinary team-based approach, individually designed to maximize function, minimize disability, promote self-acceptance, and facilitate survivor and family reintegration into the community.
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Affiliation(s)
- Alan W Young
- Complementary and Integrative Medicine Service, Department of Pain Management, Brooke Army Medical Center, JBSA, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA; Rehabilitation Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - William Scott Dewey
- Rehabilitation Services, Army Burn Center, U.S. Army Institute of Surgical Research, JBSA, 3698 Chambers Pass Suite B, Fort Sam Houston, TX 78234-7767, USA
| | - Booker T King
- Medical Corps US Army, Army Burn Center, U.S. Army Institute of Surgical Research, JBSA, 3698 Chambers Pass Suite B, Fort Sam Houston, TX 78234-7767, USA
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14
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Lambden S, Creagh-Brown BC, Hunt J, Summers C, Forni LG. Definitions and pathophysiology of vasoplegic shock. Crit Care 2018; 22:174. [PMID: 29980217 PMCID: PMC6035427 DOI: 10.1186/s13054-018-2102-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/19/2018] [Indexed: 12/18/2022] Open
Abstract
Vasoplegia is the syndrome of pathological low systemic vascular resistance, the dominant clinical feature of which is reduced blood pressure in the presence of a normal or raised cardiac output. The vasoplegic syndrome is encountered in many clinical scenarios, including septic shock, post-cardiac bypass and after surgery, burns and trauma, but despite this, uniform clinical definitions are lacking, which renders translational research in this area challenging. We discuss the role of vasoplegia in these contexts and the criteria that are used to describe it are discussed. Intrinsic processes which may drive vasoplegia, such as nitric oxide, prostanoids, endothelin-1, hydrogen sulphide and reactive oxygen species production, are reviewed and potential for therapeutic intervention explored. Extrinsic drivers, including those mediated by glucocorticoid, catecholamine and vasopressin responsiveness of the blood vessels, are also discussed. The optimum balance between maintaining adequate systemic vascular resistance against the potentially deleterious effects of treatment with catecholamines is as yet unclear, but development of novel vasoactive agents may facilitate greater understanding of the role of the differing pathways in the development of vasoplegia. In turn, this may provide insights into the best way to care for patients with this common, multifactorial condition.
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Affiliation(s)
- Simon Lambden
- University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ben C. Creagh-Brown
- Surrey Perioperative Anaesthetic Critical care collaborative group (SPACeR), Intensive Care, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Julie Hunt
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Charlotte Summers
- University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lui G. Forni
- Surrey Perioperative Anaesthetic Critical care collaborative group (SPACeR), Intensive Care, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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15
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Cardiovascular Responsiveness to Vasopressin and α1-Adrenergic Receptor Agonists After Burn Injury. J Burn Care Res 2018; 38:90-98. [PMID: 28045780 DOI: 10.1097/bcr.0000000000000374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The effects of burn injury on cardiovascular responsiveness to vasoactive agents are not well understood. The aims of this study were to determine whether burn injury alters cardiovascular reactivity to vasoactive drugs in vivo and intrinsic function of isolated mesenteric resistance arteries. Anesthetized Sprague-Dawley rats were subjected to sham procedure or 30% TBSA dorsal scald burn, followed by crystalloid resuscitation (Parkland Formula). At 24, 72, 96, and 168 hours post burn, rats were reanesthetized, and the mean arterial blood pressure (MAP) responses to various doses of the α1-adrenergic receptor agonist phenylephrine and arginine vasopressin were tested. Mesenteric arteries were harvested from uninjured animals and at 24 and 168 hours post burn. The responsiveness of arteries to phenylephrine and arginine vasopressin was tested by pressure myography. Dose response curves were generated and EC50 concentrations, Hill slopes, and maximal effects were compared. The potency of phenylephrine to increase MAP was reduced 2-fold 24 hours post burn (P < .05 vs sham) and gradually normalized at later time points. The reactivity of isolated arteries to phenylephrine was not significantly altered after burns. The potency of arginine vasopressin to increase MAP and to constrict isolated arteries was increased 2- to 3-fold at 24 hours post burn (P < .05) and normalized at later time points. Our findings suggest that burn injury differentially regulates vasopressor and blood pressure effects of α-adrenergic and vasopressin receptor agonists. Intrinsic vasopressin receptor reactivity of resistance arteries is sensitized early after burns. These findings will help to optimize resuscitation strategies and vasopressor use in difficult to resuscitate burn patients.
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16
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Nunez Lopez O, Cambiaso-Daniel J, Branski LK, Norbury WB, Herndon DN. Predicting and managing sepsis in burn patients: current perspectives. Ther Clin Risk Manag 2017; 13:1107-1117. [PMID: 28894374 PMCID: PMC5584891 DOI: 10.2147/tcrm.s119938] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Modern burn care has led to unprecedented survival rates in burn patients whose injuries were fatal a few decades ago. Along with improved survival, new challenges have emerged in the management of burn patients. Infections top the list of the most common complication after burns, and sepsis is the leading cause of death in both adult and pediatric burn patients. The diagnosis and management of sepsis in burns is complex as a tremendous hypermetabolic response secondary to burn injury can be superimposed on systemic infection, leading to organ dysfunction. The management of a septic burn patient represents a challenging scenario that is commonly encountered by providers caring for burn patients despite preventive efforts. Here, we discuss the current perspectives in the diagnosis and treatment of sepsis and septic shock in burn patients.
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Affiliation(s)
- Omar Nunez Lopez
- Department of Surgery, University of Texas Medical Branch.,Shriners Hospitals for Children, Galveston, TX, USA
| | - Janos Cambiaso-Daniel
- Department of Surgery, University of Texas Medical Branch.,Shriners Hospitals for Children, Galveston, TX, USA.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch.,Shriners Hospitals for Children, Galveston, TX, USA
| | - William B Norbury
- Department of Surgery, University of Texas Medical Branch.,Shriners Hospitals for Children, Galveston, TX, USA
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch.,Shriners Hospitals for Children, Galveston, TX, USA.,Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA
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17
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McLean L, Chen R, Kwiet J, Streimer J, Vandervord J, Kornhaber R. A clinical update on posttraumatic stress disorder in burn injury survivors. Australas Psychiatry 2017; 25:348-350. [PMID: 28372459 DOI: 10.1177/1039856217700285] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Burn injuries are complex traumatic events carrying high risks of acute physical and psychosocial morbidity. With greater survival, clinical and research attention has turned to psychosocial recovery outcomes and risk factors. It is timely to summarise current issues in posttraumatic disorders after burn injury for mental health and integrative care clinicians. Posttraumatic stress disorder (PTSD) is a common outcome of severe burn injury. There are difficulties in delivering current best practice treatments to many survivors especially those in rural and remote areas and those with comorbidities. Vicarious traumatization of clinicians, families and carers requires attention and internationally there are moves to psychosocial screening and outcome tracking. CONCLUSIONS The role of the multidisciplinary treatment, integrated and trauma-informed care is essential. While level 1 evidence for PTSD treatments theoretically applies, adaptations that consider comorbidities and treatment contexts are often essential with further research required.
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Affiliation(s)
- Loyola McLean
- Senior Staff Psychiatrist, Westmead Psychotherapy Program, WSLHD, Parramatta, NSW, and; A/Prof Course Coordinator, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Runsen Chen
- Psychologist and Student Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Julia Kwiet
- Senior Social Worker, Severe Burn Injury Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jeffrey Streimer
- Senior Staff Specialist Psychiatrist and Director of Consultation-Liaison Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - John Vandervord
- Senior Surgeon, Severe Burn Injury Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Rachel Kornhaber
- Lecturer in Nursing, Rozelle Campus, University of Tasmania, Hobart, TAS, Australia
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18
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Clarey A, Trainor D. Critical care management of severe burns and inhalational injury. ANAESTHESIA & INTENSIVE CARE MEDICINE 2017. [DOI: 10.1016/j.mpaic.2017.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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19
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Kennedy JD, Thayer W, Beuno R, Kohorst K, Kumar AB. ECMO in major burn patients: feasibility and considerations when multiple modes of mechanical ventilation fail. BURNS & TRAUMA 2017. [PMID: 28649575 PMCID: PMC5477428 DOI: 10.1186/s41038-017-0085-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND We report two cases of acute respiratory distress syndrome in burn patients who were successfully managed with good outcomes with extra corporeal membrane oxygenation (ECMO) after failing multiple conventional modes of ventilation, and review the relevant literature. CASE PRESENTATION The two patients were a 39-year-old male and 53-year-old male with modified Baux Scores of 79 and 78, respectively, with no known inhalation injury. After the initial modified Parkland-based fluid resuscitation and partial escharotomy, both patients developed worsening hypoxemia and acute respiratory distress syndrome. The hypoxemia continued to worsen on multiple modes of ventilation including volume control, pressure regulated volume control, pressure control, airway pressure release ventilation and volumetric diffusive ventilation. In both cases, the PaO2 ≤ 50 mm Hg on a FiO2 100% during the trial of mechanical ventilation. The deterioration was rapid (<12 h since onset of worsening oxygenation) in both cases. A decision was made to trial the patients on ECMO. Veno-Venous ECMO (V-V ECMO) was successfully initiated following cannulation-under transesophgeal echo guidance-with the dual lumen Avalon® (Maquet, NJ, USA) cannula. ECMO support was maintained for 4 and 24 days, respectively. Both patients were successfully weaned off ECMO and were discharged to rehabilitation following their complex hospital course. CONCLUSION Early ECMO for isolated respiratory failure in the setting on maintained hemodynamics resulted in a positive outcome in our two burn patients suffered from acute respiratory distress syndrome.
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Affiliation(s)
- Jason D Kennedy
- Department of Anesthesiology and Critical Care, Vanderbilt University Medical Center, 1211 21st Avenue S; Suite 526, Nashville, TN 37212 USA
| | - Wesley Thayer
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN USA
| | - Reuben Beuno
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN USA
| | - Kelly Kohorst
- Department of Anesthesiology and Critical Care, Vanderbilt University Medical Center, 1211 21st Avenue S; Suite 526, Nashville, TN 37212 USA
| | - Avinash B Kumar
- Department of Anesthesiology and Critical Care, Vanderbilt University Medical Center, 1211 21st Avenue S; Suite 526, Nashville, TN 37212 USA
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20
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Boluki E, Kazemian H, Peeridogaheh H, Alikhani MY, Shahabi S, Beytollahi L, Ghorbanzadeh R. Antimicrobial activity of photodynamic therapy in combination with colistin against a pan-drug resistant Acinetobacter baumannii isolated from burn patient. Photodiagnosis Photodyn Ther 2017; 18:1-5. [DOI: 10.1016/j.pdpdt.2017.01.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/20/2016] [Accepted: 01/10/2017] [Indexed: 11/28/2022]
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