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PMID:28467581
Author:Yüce Y; Acar HA; Erkal KH; Tuncay E
Address:Department of Anaesthesiology and Reanimation, Kartal Dr. Lütfi Kirdar Training and Research Hospital, Istanbul-Turkey. dryyuce@gmail.com.
Title:Can we make an early 'do not resuscitate' decision in severe burn patients?
Source:Ulus Travma Acil Cerrahi Derg; 23(2):139-143, 2017 Mar.
ISSN:1306-696X
Country of publication:Turkey
Language:eng
Abstract:BACKGROUND: The present study was conducted to examine topic of issuing early do-not-resuscitate (DNR) order at first diagnosis of patients with severe burn injuries in light of current law in Turkey and the medical literature. DNR requires withholding cardiopulmonary resuscitation in event of respiratory or cardiac arrest and allowing natural death to occur. It is frequently enacted for terminal cancer patients and elderly patients with irreversible neurological disorders. METHODS: Between January 2009 and December 2014, 29 patients (3.44%) with very severe burns were admitted to burn unit. Average total burn surface area (TBSA) was 94.24% (range: 85-100%), and in 10 patients, TBSA was 100%. Additional inhalation burns were present in 26 of the patients (89.65%). All of the patients died, despite every medical intervention. Mean survival was 4.75 days (range: 1-24 days). Total of 17 patients died within 72 hours. Lethal dose 50 (% TBSA at which certain group has 50% chance of survival) rate of our burn center is 62%. Baux indices were used for prognostic evaluation of the patients; mean total Baux score of the patients was 154.13 (range: 117-183). RESULTS: It is well known that numerous problems may be encountered during triage of severely burned patients in Turkey. These patients are referred to burn centers and are frequently transferred via air ambulance between cities, and even countries. They are intubated and mechanical ventilation is initiated at burn center. Many interventions are performed to treat these patients, such as escharotomy, fasciotomy, tangential or fascial excision, central venous catheterization and tracheostomy, or hemodialysis. Yet despite such interventions, these patients die, typically within 48 to 96 hours. Integrity of the body is often lost as result of aggressive intervention with no real benefit, and there are also economic costs to hospital related to use of materials, bed occupancy, and distribution of workforce. For these reasons, as well as patient comfort, early do-not-resuscitate or do-not-intubate protocol for these patients is suggested. Resources could then be directed to other patients with high expectancy of life and patients with burns that are beyond treatment can experience more comfortable end of life. CONCLUSION: At present in Turkey, it is not possible to give DNR order for patient with severe burns that are incompatible with survival due to legal interdiction. This subject should be discussed at high-level meetings with participation of doctors, legal experts, economists, and theologians.
Publication type:JOURNAL ARTICLE


  2 / 1044 MEDLINE  
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PMID:28358811
Author:Walsh DM; McCullough SD; Yourstone S; Jones SW; Cairns BA; Jones CD; Jaspers I; Diaz-Sanchez D
Address:Curriculum in Toxicology, University of North Carolina, Chapel Hill, North Carolina, United States of America.
Title:Alterations in airway microbiota in patients with PaO2/FiO2 ratio ≤ 300 after burn and inhalation injury.
Source:PLoS One; 12(3):e0173848, 2017.
ISSN:1932-6203
Country of publication:United States
Language:eng
Abstract:BACKGROUND: Injury to the airways after smoke inhalation is a major mortality risk factor in victims of burn injuries, resulting in a 15-45% increase in patient deaths. Damage to the airways by smoke may induce acute respiratory distress syndrome (ARDS), which is partly characterized by hypoxemia in the airways. While ARDS has been associated with bacterial infection, the impact of hypoxemia on airway microbiota is unknown. Our objective was to identify differences in microbiota within the airways of burn patients who develop hypoxemia early after inhalation injury and those that do not using next-generation sequencing of bacterial 16S rRNA genes. RESULTS: DNA was extracted from therapeutic bronchial washings of 48 patients performed within 72 hours of hospitalization for burn and inhalation injury at the North Carolina Jaycee Burn Center. DNA was prepared for sequencing using a novel molecule tagging method and sequenced on the Illumina MiSeq platform. Bacterial species were identified using the MTToolbox pipeline. Patients with hypoxemia, as indicated by a PaO2/FiO2 ratio ≤ 300, had a 30% increase in abundance of Streptococcaceae and Enterobacteriaceae and 84% increase in Staphylococcaceae as compared to patients with a PaO2/FiO2 ratio > 300. Wilcoxon rank-sum test identified significant enrichment in abundance of OTUs identified as Prevotella melaninogenica (p = 0.042), Corynebacterium (p = 0.037) and Mogibacterium (p = 0.048). Linear discriminant effect size analysis (LefSe) confirmed significant enrichment of Prevotella melaninognica among patients with a PaO2/FiO2 ratio ≤ 300 (p<0.05). These results could not be explained by differences in antibiotic treatment. CONCLUSIONS: The airway microbiota following burn and inhalation injury is altered in patients with a PaO2/FiO2 ratio ≤ 300 early after injury. Enrichment of specific taxa in patients with a PaO2/FiO2 ratio ≤ 300 may indicate airway environment and patient changes that favor these microbes. Longitudinal studies are necessary to identify stably colonizing taxa that play roles in hypoxemia and ARDS pathogenesis.
Publication type:JOURNAL ARTICLE
Name of substance:0 (RNA, Ribosomal, 16S)


  3 / 1044 MEDLINE  
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PMID:28126446
Author:Graham RE; Huzar TF
Address:Dunn Burn Center, Memorial Hermann-Texas Medical Center, Houston, TX, United States. Electronic address: russell.graham@memorialhermann.org.
Title:Letter to the Editor, RE: "Incidence of ventilator associated pneumonia in burn patients with inhalation injury treated with high frequency percussive ventilation versus volume control ventilation: A systematic review" by Haitham S. Al Ashry, George Mansour, Andre Kalil, Ryan Walters, Renuga Vivekanandan [Burns 42, (2016) (September (6)) 1193-1200].
Source:Burns; 43(3):688-689, 2017 05.
ISSN:1879-1409
Country of publication:Netherlands
Language:eng
Publication type:LETTER; COMMENT


  4 / 1044 MEDLINE  
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PMID:28040370
Author:Hsu PS; Tsai YT; Lin CY; Chen SG; Dai NT; Chen CJ; Chen JL; Tsai CS
Address:Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Title:Benefit of extracorporeal membrane oxygenation in major burns after stun grenade explosion: Experience from a single military medical center.
Source:Burns; 43(3):674-680, 2017 May.
ISSN:1879-1409
Country of publication:Netherlands
Language:eng
Abstract:INTRODUCTION: Explosion injury is very common on the battlefield and is associated with major burn and inhalation injuries and subsequent high mortality and morbidity rates. Here we report six victims who suffered from explosion injuries caused by stun grenade; all were treated with extracorporeal membrane oxygenation (ECMO) as salvage therapy. This study was aimed to evaluate the indications and efficacy of ECMO in acute and critically ill major burn patients. METHODS: This was a retrospective analysis of six patients from Tri-Service General Hospital, National Defense Medical Center in Taiwan. All suffered from major burns with 89.0±19.1% average of total body surface area over second degree (TBSA; range, 50-99%). ECMO was used due to inhalation injury in five patients and cardiogenic shock in one patient. The average interval to start ECMO was 26.5±19.0h (range, 14-63h). Venoarterial ECMO was used on in four patients due to unstable hemodynamic status, whereas venovenous ECMO was used in two patients for sustained hypoxemia. RESULTS: All patients had rhabdomyolysis with acute renal failure. The average duration of ECMO was 169.6±180.9h (range, 27-401h). All patients developed coagulopathy and needed debridement surgery during ECMO support, and five underwent torso escharotomy due to inspiratory compromise. Only one patient whose second and third degree burns covered 50% TBSA was successfully weaned from ECMO and survived; he was discharged after 221 hospital days. All patients who died had second and third degree burns covering over 90% of their TBSA. Three patients died of multiple organ failure, one died of septic shock, and the other died of cardiogenic shock. Overall survival rate was 16.7%. CONCLUSIONS: In acute and critically ill major burn patients, ECMO could be considered as a salvage therapy, particularly in those with inhalation injury and burn-related acute respiratory distress syndrome. However, ECMO does not seem to provide benefits for circulatory support in those with hemodynamic compromise. The use of ECMO in these patients is still investigational, as our data provided no benefit in terms of the outcomes or survival, particularly in those with more than 90% TBSA burns.
Publication type:JOURNAL ARTICLE


  5 / 1044 MEDLINE  
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PMID:27863270
Author:Kumar AB; Andrews W; Shi Y; Shotwell MS; Dennis S; Wanderer J; Summitt B
Address:Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37212. Electronic address: avinash.b.kumar@vanderbilt.edu.
Title:Fluid resuscitation mediates the association between inhalational burn injury and acute kidney injury in the major burn population.
Source:J Crit Care; 38:62-67, 2017 Apr.
ISSN:1557-8615
Country of publication:United States
Language:eng
Abstract:BACKGROUND: It is known that acute respiratory distress syndrome and acute lung injury are independent risk factors for developing acute kidney injury (AKI) through complex pathophysiologic mechanisms. Our specific aim is to evaluate the risk factors for AKI postburn injury and whether inhalation thermal injury is an independent risk factor for developing AKI in the major burn population. METHODS: This is an institutional review board-approved, retrospective cohort study of patients admitted to a tertiary burn intensive care unit between 2011 and 2013. We included adults (age 18 years or older) with major burn injury greater than or equal to 20% total burn surface area (TBSA) and patients with confirmed inhalation injury (±major burn). Acute kidney injury was defined using the acute kidney injury network serum creatinine criteria up to 5 days after admission. Patient demographics and clinical data were compared across cohorts using the Wilcoxon rank sum test or Pearson χ test, as appropriate. Multiple logistic regression was used to assess the effect of inhalation injury and major burn on the incidence of AKI, adjusting for clinical and demographic confounders. RESULTS: Two hundred fifty-four patient records (90 with inhalation injury and 164 with major burn only) were evaluated. The mean age on admission was 47±19 years and 72% of the cohort were men. There were more men in the major burn group (78% vs 62%; P=.007). No other significant differences were observed in the baseline demographics. The overall incidence of AKI was 28% (95% confidence interval, 22, 33). The unadjusted odds of AKI were nearly double (odds ratio, 1.99; 95% confidence interval, 1.13, 3.49) among those with inhalation injury relative to those with major burn only. However, there was no evidence of an independent inhalational injury effect after adjusting for potential confounders. In particular, TBSA (P=.051), daily 24-hour fluid balance (P<.001), and most recent 24-hour albumin transfusion status (P=.002) were all significantly associated with AKI in the adjusted analysis. Age and packed red blood cell transfusion status were not significant. CONCLUSION: Inhalation thermal injury is not an independent risk factor for AKI after adjusting for TBSA and surrogates for fluid resuscitation. In patients with major burns, intensity of fluid resuscitation may mediate the development of AKI.
Publication type:JOURNAL ARTICLE
Name of substance:AYI8EX34EU (Creatinine)


  6 / 1044 MEDLINE  
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PMID:27305870
Author:Dion GR; Teng S; Bing R; Hiwatashi N; Amin MR; Branski RC
Address:NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A.
Title:Development of an in vivo model of laryngeal burn injury.
Source:Laryngoscope; 127(1):186-190, 2017 Jan.
ISSN:1531-4995
Country of publication:United States
Language:eng
Abstract:OBJECTIVES/HYPOTHESIS: Inhalation injury significantly increases morbidity and mortality in burn patients. Approximately one in five burn patients have acute injury to the larynx, trachea, and/or lungs-and as many as 70% have long-term laryngeal abnormalities. Although inhalation injury to the lung has been studied extensively, no models exist to study these insults to the larynx. As such, we developed an in vivo rabbit model to create precise and reproducible laryngeal burn with resultant tissue damage as a foundation for interventional studies. METHODS: Following tubeless tracheotomy, a custom temperature-control device was employed to apply heated air (70°C-80°C, 150°C-160°C, or 310°C-320°C) ± smoke derived from unbleached cotton to the larynx, endoscopically, minimizing adjacent tissue damage in six rabbits. Pain, nutrition, and level of activity were monitored. Direct laryngoscopy and histological examination were performed 24 hours following insult. RESULTS: All animals survived injury with appropriate pain control; oral intake was initiated and all were adequately ventilating via tracheostomy. Burn sequelae were noted under direct visualization 24 hours after injury, and graded levels of edema and tissue damage were observed as a function of temperature. Edema obstructed true vocal fold visualization at increased temperatures. These injury patterns correlated with graded tissue damage on histology. CONCLUSION: We created an in vivo model of laryngeal burn injury employing a custom burn device resulting in graded tissue injury. This model is critical for investigation of the mechanisms underlying burn injury, and ultimately, the development and evaluation of therapies for this challenging population. LEVEL OF EVIDENCE: NA Laryngoscope, 127:186-190, 2017.
Publication type:JOURNAL ARTICLE


  7 / 1044 MEDLINE  
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PMID:27518664
Author:Sheridan RL
Address:From the Burn Service, Shriners Hospital for Children, the Division of Burns, Massachusetts General Hospital, and the Department of Surgery, Harvard Medical School - all in Boston.
Title:Fire-Related Inhalation Injury.
Source:N Engl J Med; 375(5):464-9, 2016 Aug 04.
ISSN:1533-4406
Country of publication:United States
Language:eng
Publication type:JOURNAL ARTICLE; REVIEW


  8 / 1044 MEDLINE  
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PMID:27502609
Author:Soussi S; Gallais P; Kachatryan L; Benyamina M; Ferry A; Cupaciu A; Chaussard M; Maurel V; Chaouat M; Mimoun M; Mebazza A; Legrand M; PRONOBURN Group
Address:Department of Anesthesiology and Critical Care and Burn Unit, Hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75010, Paris, France.
Title:Extracorporeal membrane oxygenation in burn patients with refractory acute respiratory distress syndrome leads to 28 % 90-day survival.
Source:Intensive Care Med; 42(11):1826-1827, 2016 Nov.
ISSN:1432-1238
Country of publication:United States
Language:eng
Publication type:LETTER


  9 / 1044 MEDLINE  
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PMID:26971391
Author:Yoshino Y; Ohtsuka M; Kawaguchi M; Sakai K; Hashimoto A; Hayashi M; Madokoro N; Asano Y; Abe M; Ishii T; Isei T; Ito T; Inoue Y; Imafuku S; Irisawa R; Ohtsuka M; Ogawa F; Kadono T; Kawakami T; Kukino R; Kono T; Kodera M; Takahara M; Tanioka M; Nakanishi T; Nakamura Y; Hasegawa M; Fujimoto M; Fujiwara H; Maekawa T; Matsuo K; Yamasaki O; Le Pavoux A; Tachibana T; Ihn H; Wound/Burn Guidelines Committee
Address:Department of Dermatology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
Title:The wound/burn guidelines - 6: Guidelines for the management of burns.
Source:J Dermatol; 43(9):989-1010, 2016 Sep.
ISSN:1346-8138
Country of publication:England
Language:eng
Abstract:Burns are a common type of skin injury encountered at all levels of medical facilities from private clinics to core hospitals. Minor burns heal by topical treatment alone, but moderate to severe burns require systemic management, and skin grafting is often necessary also for topical treatment. Inappropriate initial treatment or delay of initial treatment may exert adverse effects on the subsequent treatment and course. Therefore, accurate evaluation of the severity and initiation of appropriate treatment are necessary. The Guidelines for the Management of Burn Injuries were issued in March 2009 from the Japanese Society for Burn Injuries as guidelines concerning burns, but they were focused on the treatment for extensive and severe burns in the acute period. Therefore, we prepared guidelines intended to support the appropriate diagnosis and initial treatment for patients with burns that are commonly encountered including minor as well as moderate and severe cases. Because of this intention of the present guidelines, there is no recommendation of individual surgical procedures.
Publication type:JOURNAL ARTICLE; PRACTICE GUIDELINE
Name of substance:0 (Adrenal Cortex Hormones); 0 (Anti-Bacterial Agents); 0 (Anti-Infective Agents, Local); 0 (Ointments); 0 (Tetanus Toxoid); W46JY43EJR (Silver Sulfadiazine)


  10 / 1044 MEDLINE  
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PMID:26902279
Author:Feng S; Jia C; Liu Z; Lyu X
Address:Department of Burns and Plastic Surgery, the 309th Hospital of PLA, Beijing 100091, China.
Title:[Advances in the research of pathogenesis and treatment of severe smoke inhalation injury].
Source:Zhonghua Shao Shang Za Zhi; 32(2):122-5, 2016 Feb.
ISSN:1009-2587
Country of publication:China
Language:chi
Abstract:Among the fire victims, respiratory tract injury resulted from smoke inhalation is the major cause of death. Particulate substances in smoke, toxic and harmful gas, and chemical substances act together would rapidly induce the occurrence of dramatic pathophysiologic reaction in the respiratory tract, resulting in acute injury to the respiratory tract, thus inducing serious injury to it and acute respiratory distress syndrome, leading to death of the victims. In recent years, the pathophysiologic mechanism of severe smoke inhalation injury has been gradually clarified, thus appreciable advances in its treatment have been achieved. This paper is a brief review of above-mentioned aspects.
Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
Name of substance:0 (Smoke)



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