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Yu L, Du W, Shen Y. A man with swollen, numb fingers. BMJ 2024; 386:e078584. [PMID: 39025513 DOI: 10.1136/bmj-2023-078584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Affiliation(s)
- Lu Yu
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Capital Medical University Clinical Center for Wounds, Capital Medical University, Beijing, China
| | - Weili Du
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Capital Medical University Clinical Center for Wounds, Capital Medical University, Beijing, China
| | - Yuming Shen
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Capital Medical University Clinical Center for Wounds, Capital Medical University, Beijing, China
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Kenworthy P, Phillips M, Grisbrook TL, Gibson W, Wood FM, Edgar DW. An objective measure for the assessment and management of fluid shifts in acute major burns. BURNS & TRAUMA 2018; 6:3. [PMID: 30009191 PMCID: PMC6040607 DOI: 10.1186/s41038-017-0105-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/19/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Major burns are life threatening. Fluid resuscitation is required for survival to maintain intravascular volumes and prevent hypovolemic shock. Bioimpedance spectroscopy (BIS) has been recognised as a potential method of monitoring fluid shifts after burn and in other disease states. The aims of this study were to examine the reliability of BIS across different dressing conditions and electrode positions, establish the influence of Acticoat™ on BIS variable measures and determine the validity of whole-body BIS to assess net fluid shift in the presence of moderate to major burns. METHODS An observational longitudinal cohort study was conducted from December 2014 to February 2016. Patients with over 15% total body surface area (TBSA) burns and injury less than 48 h were enrolled in the study. BIS triplicate measures were collected in an open wound and with an ActicoatTM dressing (at 5 half hour intervals). Standard and alternate electrode placements were utilised for the reliability analysis and standard placement only for determining the validity of BIS in moderate to major burns. The ImpediMde SFB7 was used to collect whole-body and segmental BIS measures. Stata statistical software, release 14 was utilised to analyse all results. Descriptive analyses were performed and were reported using the means and standard deviations (SD). RESULTS BIS-repeated measures established BIS raw resistance (R), and predicted volume variables were reliable in any condition (intra-class correlation coefficient (ICC) 0.996-0.999, 95% confidence intervals (CI) 0.996-0.999) without a systematic difference. Acticoat™ dressings significantly influenced all BIS-predicted volumes (p ≤ 0.01) as determined by multilevel mixed effects (MLME) linear regression analysis. Validity of BIS was demonstrated by resistance variables significantly decreasing with increasing net ionic fluid shift and increased TBSA (severity of injury) and calculated fluid volumes increasing with increasing net fluid shift and TBSA. BIS resistance also decreased with time as oedema reduced. For clinical use, a calculator was developed to adjust BIS variables when an Acticoat™ dressing is in situ, thus facilitating BIS variable change estimates in real time, with dressings intact. CONCLUSION BIS may be used clinically to monitor fluid volume change in major acute burns.
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Affiliation(s)
- Pippa Kenworthy
- Fiona Wood Foundation, Fiona Stanley Hospital, Perth, Western Australia Australia
- Burns Service of Western Australia, Fiona Stanley Hospital, Perth, Western Australia Australia
- School of Physiotherapy, Notre Dame University, Fremantle, Western Australia Australia
- Adult State Burns Service, Fiona Stanley Hospital, Murdoch Drive, Murdoch, Western Australia 6150 Australia
| | - Michael Phillips
- Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, Western Australia Australia
| | - Tiffany L. Grisbrook
- Fiona Wood Foundation, Fiona Stanley Hospital, Perth, Western Australia Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia Australia
| | - William Gibson
- School of Physiotherapy, Notre Dame University, Fremantle, Western Australia Australia
| | - Fiona M. Wood
- Fiona Wood Foundation, Fiona Stanley Hospital, Perth, Western Australia Australia
- Burns Service of Western Australia, Fiona Stanley Hospital, Perth, Western Australia Australia
| | - Dale W. Edgar
- Fiona Wood Foundation, Fiona Stanley Hospital, Perth, Western Australia Australia
- Burns Service of Western Australia, Fiona Stanley Hospital, Perth, Western Australia Australia
- Burn Injury Research Node, Notre Dame University, Fremantle, Western Australia Australia
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Abstract
Although every disaster scenario is unique, certain themes have emerged repeatedly during management of burn disasters. These lessons learned are useful when planning an individual burn unit's role in future disaster response.
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Affiliation(s)
- Robert L Sheridan
- Boston Shriners Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA.
| | - Jonathan Friedstat
- Boston Shriners Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA
| | - Kaitlyn Votta
- Boston Shriners Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA
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Rashaan ZM, Krijnen P, van den Akker-van Marle ME, van Baar ME, Vloemans AFP, Dokter J, Tempelman FRH, van der Vlies CH, Breederveld RS. Clinical effectiveness, quality of life and cost-effectiveness of Flaminal® versus Flamazine® in the treatment of partial thickness burns: study protocol for a randomized controlled trial. Trials 2016; 17:122. [PMID: 26945575 PMCID: PMC4779241 DOI: 10.1186/s13063-016-1240-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 02/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Partial thickness burns are painful, difficult to manage and can have a negative effect on quality of life through scarring, permanent disfigurement and loss of function. The aim of burn treatment in partial thickness burns is to save lives, stimulate wound healing by creating an optimumly moist wound environment, to have debriding and analgesic effects, protect the wound from infection and be convenient for the patient and caregivers. However, there is no consensus on the optimal treatment of partial thickness wounds. Flaminal® and Flamazine® are two standard treatment options that provide the above mentioned properties in burn treatment. Nevertheless, no randomized controlled study has yet compared these two common treatment modalities in partial thickness burns. Thus, the aim of this study is to evaluate the clinical effectiveness, quality of life and cost-effectiveness of Flaminal® versus Flamazine® in the treatment of partial thickness burns. Methods/Design In this two-arm open multi-center randomized controlled trial, 90 patients will be randomized between Flaminal® and Flamazine® and followed for 12 months. The study population will consist of competent or temporarily non-competent (because of sedation and/or intubation) patients, 18 years of age or older, with acute partial thickness burns and a total body surface area (TBSA) of less than 30 %. The main study outcome is time to complete re-epithelialization (greater than 95 %). Secondary outcome measures include need for grafting, wound colonization/infection, number of dressing changes, pain and anxiety, scar formation, health-related quality of life (HRQoL), and costs. Discussion This study will contribute to the optimal treatment of patients with partial thickness burn wounds and will provide evidence on the (cost-)effectiveness and quality of life of Flaminal® versus Flamazine® in the treatment of partial thickness burns. Trial registration Netherlands Trial Register NTR4486, registered on 2 April 2014.
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Affiliation(s)
- Zjir M Rashaan
- Department of Surgery, Leiden University Medical Center, Postbus 9600, 2333 ZA, Leiden, The Netherlands. .,Burn Centre, Red Cross Hospital Beverwijk, Postbus 1074, 1942 LE, Beverwijk, The Netherlands.
| | - Pieta Krijnen
- Department of Surgery, Leiden University Medical Center, Postbus 9600, 2333 ZA, Leiden, The Netherlands.
| | | | - Margriet E van Baar
- Association of Dutch Burn Centres, Postbus 1015, 1940 EA, Beverwijk, The Netherlands. .,Burn Centre, Maasstad Hospital, PO Box 9100, 3079 DZ, Rotterdam, The Netherlands.
| | - Adrianus F P Vloemans
- Burn Centre, Red Cross Hospital Beverwijk, Postbus 1074, 1942 LE, Beverwijk, The Netherlands.
| | - Jan Dokter
- Burn Centre, Maasstad Hospital, PO Box 9100, 3079 DZ, Rotterdam, The Netherlands.
| | - Fenike R H Tempelman
- Burn Centre, Red Cross Hospital Beverwijk, Postbus 1074, 1942 LE, Beverwijk, The Netherlands.
| | - Cees H van der Vlies
- Burn Centre, Maasstad Hospital, PO Box 9100, 3079 DZ, Rotterdam, The Netherlands.
| | - Roelf S Breederveld
- Department of Surgery, Leiden University Medical Center, Postbus 9600, 2333 ZA, Leiden, The Netherlands. .,Burn Centre, Red Cross Hospital Beverwijk, Postbus 1074, 1942 LE, Beverwijk, The Netherlands. .,Association of Dutch Burn Centres, Postbus 1015, 1940 EA, Beverwijk, The Netherlands.
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Abstract
OBJECTIVES To characterize the epidemiology of burn injury in pediatric patients and identify factors associated with mortality based on burn severity. DESIGN Retrospective cohort study. SETTING U.S. military combat support hospitals and forward surgical hospitals in Iraq and Afghanistan. PATIENTS Iraqi and Afghan children less than 18 years old admitted with isolated burn injury. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Burn severity was classified as mild, moderate, and severe based on external Abbreviated Injury Scale score. Patient characteristics and outcomes were described according to burn severity. A multivariate logistic regression was performed on univariate associations with mortality. Of 4,743 pediatric patients, 549 (11.6%) had isolated burn injury. Overall mortality was 13%, median external Abbreviated Injury Scale was 3 (interquartile range, 2-4), and 67% were male. Variables included in the logistic regression were external Abbreviated Injury Scale score, abnormal heart rate for age, hypotension, mechanical ventilation, transfusion, Glasgow Coma Scale, international normalized ratio, base deficit, hematocrit, and platelet count. Factors independently associated with mortality were international normalized ratio (odds ratio, 2.6; 95% CI, 1.2-5.8; p = 0.021) and external Abbreviated Injury Scale (odds ratio, 2.5; 95% CI, 1.3-4.7; p = 0.004). Mortality increased with burn severity: mild 1.7%, moderate 7.2%, and severe 47% (p < 0.001). CONCLUSIONS This is the first in-depth study of pediatric burn injuries in combat. Children with severe burns (total body surface area > 39% or > 29% if < 5 yr) had a high mortality and required significant resources in a setting that is not primarily resourced for long-term care of severe pediatric burn injury. Extraordinary measures are therefore used for the long-term care of these burned children within the war zones of Iraq and Afghanistan.
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