1
|
Gwyn-Jones A, Afolabi T, Bonney S, Gurusinghe D, Tridente A, Mahambrey T, Nee P. Major burns in adults: a practice review. Emerg Med J 2024:emermed-2024-214046. [PMID: 38886061 DOI: 10.1136/emermed-2024-214046] [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: 03/13/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024]
Abstract
There are approximately 180 000 deaths per year from thermal burn injury worldwide. Most burn injuries can be treated in local hospitals but 6.5% require specialist burn care. The initial ED assessment, resuscitation and critical care of the severely burned patient present significant challenges and require a multidisciplinary approach. The management of these patients in the resuscitation room impacts on the effectiveness of continuing care in the intensive care unit. The scope of the present practice review is the immediate management of the adult patient with severe burns, including inhalation injury and burn shock. The article uses an illustrative case to highlight recent developments including advanced airway management and the contemporary approach to assessment of fluid requirements and the type and volume of fluid resuscitation. There is discussion on new options for pain relief in the ED and the principles governing the early stages of burn intensive care. It does not discuss minor injuries, mass casualty events, chemical or radiation injuries, exfoliative or necrotising conditions or frost bite.
Collapse
Affiliation(s)
- Alice Gwyn-Jones
- Emergency Department, St Helens and Knowsley Hospitals NHS Trust, Prescot, UK
| | - Tijesu Afolabi
- Emergency Department, St Helens and Knowsley Hospitals NHS Trust, Prescot, UK
| | | | - Dilnath Gurusinghe
- Emergency Department, St Helens and Knowsley Hospitals NHS Trust, Prescot, UK
| | - Ascanio Tridente
- Emergency Department, St Helens and Knowsley Hospitals NHS Trust, Prescot, UK
| | | | - Patrick Nee
- Emergency Department, St Helens and Knowsley Hospitals NHS Trust, Prescot, UK
- Liverpool John Moores University, Liverpool, UK
| |
Collapse
|
2
|
Țichil I, Rus IC, Cenariu D, Fodor L, Mitre I. Blood transfusions in non-major burns patients. Burns 2023; 49:1808-1815. [PMID: 37867053 DOI: 10.1016/j.burns.2023.09.018] [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: 05/15/2023] [Revised: 09/07/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Blood transfusions are essential to treating anaemia of burn injuries. It has recently been observed that patients with non-major burns < 20%TBSA may also develop anaemia requiring transfusion of blood products. Due to the morbidity and mortality rate associated with blood transfusions better understanding of risk factors may guide clinical practices to improve patient care. OBJECTIVE To determine risk factors for transfusion of blood products in patients with non-major burn injuries and assess transfusion practices to establish impact on patient outcome. METHOD Our study included 182 adult patients with non-major burn injuries, < 20%TBSA admitted over a 3-year period at the Department of Plastic Surgery and Burns Unit of the Emergency County Hospital Cluj-Napoca. We analysed patient and injury characteristics: age, gender, %TBSA burn, %FT burn, burn site, mechanism of injury, inhalation injury, Hb lab determinations throughout admission and surgical management. Charlson comorbidities index has been determined based on cardiovascular, neurological, gastrointestinal and renal comorbidities as well as diabetes mellitus. We selected blood transfusions, wound infections and length of hospital stay as outcome for our analysis. RESULTS 37.9% of patients included in our study developed anaemia throughout admission and 7.7% underwent blood transfusions. Mean Hb levels triggering blood transfusions have been recorded at 7.4 (IQR=8.8-9.9) g/dL. Patients who received transfusions were older, presented with higher %TBSA and associated a higher comorbidity index. They also tended to develop coagulopathy and underwent more surgical procedures to achieve wound closure. In transfused patients who associate comorbidities we observed a higher rate of wound infections and longer hospital stay. CONCLUSIONS Patient related comorbidities correlate with higher transfusion rates in non-major burn injuries. Due to the risk associated with the use of blood products decision to transfuse should adhere to current guideline practices and be tailored to specific patient requirements.
Collapse
Affiliation(s)
- Ioana Țichil
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania; Emergency County Hospital, 3-5 Clinicilor Street, 400006 Cluj-Napoca, Romania; Department of Haematology "Ion Chiricuta" Institute of Oncology, 34-36 Republicii Street, Cluj-Napoca 400015, Romania.
| | - Ioana Codruta Rus
- Department of Haematology "Ion Chiricuta" Institute of Oncology, 34-36 Republicii Street, Cluj-Napoca 400015, Romania
| | - Diana Cenariu
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania; MEDFUTURE - Research Centre for Advanced Medicine, 8 Louis Pasteur Street, 400347 Cluj-Napoca, Romania
| | - Lucian Fodor
- Emergency County Hospital, 3-5 Clinicilor Street, 400006 Cluj-Napoca, Romania
| | - Ileana Mitre
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania; Emergency County Hospital, 3-5 Clinicilor Street, 400006 Cluj-Napoca, Romania
| |
Collapse
|
3
|
Souto J, Rodrigues AG. Reducing Blood Loss in a Burn Care Unit: A Review of Its Key Determinants. J Burn Care Res 2023; 44:459-466. [PMID: 36106386 DOI: 10.1093/jbcr/irac114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with a major burn injury differ considerably from the typical critical ill and trauma population. Very often, burn patients suffer from anemia throughout their hospital stay. This is caused both by combination of persistent blood loss with decreased erythropoiesis. Therefore, burn patients do have major transfusion requirements. However, transfusion is not devoid of risks or costs. We hereby review the best surgical techniques and medical approaches, aiming to reduce blood loss in a burn patient and optimize red cell production, so that we can reduce the need of RBC transfusion. The implementation of a combination of surgical techniques aiming to reduce blood loss and medical care approaches to prevent anemia, rather than single attitudes, should be adopted in burn care. There is an urgent need for clear guidelines that can easily be accepted, applied, and spread across different burn units to methodically implement measures to reduce blood loss and transfusion needs, and ultimately improve burn patients' outcome and the health care financial status.
Collapse
Affiliation(s)
- João Souto
- Faculty of Medicine, University of Porto, Portugal
| | - Acacio Goncalves Rodrigues
- Burn Unit and Department of Plastic and Reconstructive Surgery, Faculty of Medicine, S. João University Hospital Center, Porto, Portugal.,CINTESIS@RISE, Faculty of Medicine, University of Porto, Portugal
| |
Collapse
|
4
|
Cenariu D, Bumbea H, Colita A, Constantinescu C, Desmirean M, Iluta S, Lysák D, Mussetti A, Tichil I, Tanase A, Tomuleasa C. Progress in Hematopoietic Stem Cell Transplantation and Cellular Therapies. J Clin Med 2022; 11:jcm11247354. [PMID: 36555970 PMCID: PMC9784161 DOI: 10.3390/jcm11247354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Hematological malignancies are considered to be one of the most important causes of mortality and morbidity in the modern world [...].
Collapse
Affiliation(s)
- Diana Cenariu
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Horia Bumbea
- Department of Stem Cell Transplantation, University Emergency Hospital Bucharest, 022314 Bucharest, Romania
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, 022314 Bucharest, Romania
| | - Anca Colita
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, 022314 Bucharest, Romania
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Catalin Constantinescu
- Intensive Care Unit, Emergency Hospital, 400006 Cluj-Napoca, Romania
- Department of Anesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Minodora Desmirean
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Sabina Iluta
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400124 Cluj Napoca, Romania
| | - Daniel Lysák
- Department of Hematology and Oncology, University Hospital Pilsen, 32300 Pilsen, Czech Republic
- Faculty of Medicine in Pilsen, Charles University, 32300 Pilsen, Czech Republic
| | - Alberto Mussetti
- Clinical Hematology Department, Institut Català d’Oncologia-Hospitalet, 08901 Barcelona, Spain
- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), 08908 Barcelona, Spain
| | - Ioana Tichil
- Department of Anesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Alina Tanase
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, 022314 Bucharest, Romania
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Ciprian Tomuleasa
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400124 Cluj Napoca, Romania
- Correspondence:
| |
Collapse
|
5
|
Peng C, Yang F, Yu J, Chen C, He J, Jin Z. Temporal trends, predictors of blood transfusion and in-hospital outcomes among patients with severe burn injury in the United States-A national database-based analysis. Transfusion 2022; 62:1537-1550. [PMID: 35789008 DOI: 10.1111/trf.16999] [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: 12/23/2021] [Revised: 04/13/2022] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Severe burn can be accompanied by life-threatening bleeding on some occasions, thus, blood transfusion is often required in these patients during their hospitalization. Therefore, we aimed to examine temporal trends, predictors, and in-hospital outcomes of blood transfusion in these patients in the United States. METHODS The National Inpatient Sample was used to identify severe burn patients between January 2010 and September 2017 in the United States. Trends in the utilization of blood transfusion were analyzed using the Cochran-Armitage trend test. Moreover, propensity score matching (PSM) was employed, and then in-hospital outcomes were compared between these two groups in the matched cohort. Multivariable logistic regressions were further used to validate the results of PSM. RESULTS Among 27,260 severe burn patients identified during the study period, 2120 patients (7.18%) received blood transfusion. Blood transfusion rates decreased significantly from 9.52% in 2010 to 5.02% in 2017 (p for trend <.001). In the propensity-matched cohort (2120 pairs with and without transfusion), patients transfused were at increased risk of in-hospital mortality (13.3% vs 8.77%, p < .001), overall postoperative complications (88.3% vs 72.59%, p < .001), longer hospital stays (defined as > median hospital stays = 5 d) (73.8% vs 50.6%, p < .001) and increased overall cost (defined as > median overall costs = 30,746) (81.6% vs 57.3%, p < .001). This was also the case for the multivariable analysis. CONCLUSIONS Blood transfusion following severe burn injury may be associated with worse clinical outcomes. The utility for blood transfusion in burn patients warrants further prospective exploration.
Collapse
Affiliation(s)
- Chi Peng
- Department of Health Statistics, The Second Military Medical University, Shanghai, China
| | - Fan Yang
- Department of Plastic Surgery and Burns, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China.,Institute of Pathology and Southwest Cancer Center, Southwest Hospital, The Third Military Medical University, Chongqing, China
| | - Jian Yu
- Department of Health Statistics, The Second Military Medical University, Shanghai, China
| | - Chenxin Chen
- Department of Health Statistics, The Second Military Medical University, Shanghai, China
| | - Jia He
- Department of Health Statistics, The Second Military Medical University, Shanghai, China
| | - Zhichao Jin
- Department of Health Statistics, The Second Military Medical University, Shanghai, China
| |
Collapse
|
6
|
Jung M, Harish V, Wijewardena A, Kerridge I, Gillies R. Management strategies for perioperative anaemia in the severely burn-injured Jehovah’s Witness patients who decline a blood transfusion: A systematic review with illustrative case reports. Burns 2022; 49:716-729. [PMID: 35941026 DOI: 10.1016/j.burns.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/09/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The management of severe burn-injured Jehovah's Witness patients who decline a blood transfusion poses unique challenges. The literature is scant for guiding perioperative anaemia management in these patients. We present a systematic review of this patient group, along with illustrative, consecutive case reports of our experience. METHODS A systematic review was performed on Embase, MEDLINE and PubMed databases on articles discussing the treatment of burn-injured Jehovah's Witness patients. Articles were excluded if discussing isolated inhalation injury, or if blood transfusions were permitted. RESULTS Nine articles including a total of 11 patients revealed consistent themes. A multimodal medical and surgical approach is suggested. Medical strategies are directed at reducing blood loss and optimising haematopoiesis and include rationalising blood collection, reversing coagulopathy, administering tranexamic acid and regular erythropoietin. Surgical strategies include staged aggressive debridement, tumescent adrenaline infiltration and limb tourniquets. We found that the argon beam coagulator was an effective haemostatic adjunct not previously described in literature. DISCUSSION Management of anaemia in severely burn-injured Jehovah's Witness patients is challenging. This systematic review presents a summary of strategies directed at minimising blood loss, and optimising haematopoiesis. Careful preoperative planning, meticulous surgical technique, and postoperative physiological support are caveats to success.
Collapse
|