Journal of burn care & research : official publication of the American Burn Association
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Acute respiratory distress syndrome (ARDS) remains a challenging disease leading to increased mortality in burn patients, and inhalation injury may contribute to the development of severe ARDS. Extracorporeal life support (ECLS) provides a method of gas exchange while allowing time for lung recovery in the setting of early, severe ARDS. Recent study suggests that a selected population of patients with severe ARDS may benefit from ECLS, especially if initiated early. ⋯ The patient was discharged home on hospital day 50 on room air. ECLS aids innate lung recovery by allowing time for the diminution of high peak inspiratory pressures, prevention of barotrauma, and ultimately mitigating ventilator-induced lung injury. ECLS should be considered early as a viable supportive modality after inhalational injury in patients failing advanced ARDS management strategies.
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Practice Guideline
American Burn Association Practice guidelines for prevention, diagnosis, and treatment of ventilator-associated pneumonia (VAP) in burn patients.
The purpose of this guideline is to review the available published literature on ventilator-associated pneumonia (VAP) as it pertains to the burn patient. It provides an evidence-based recommendation for the prevention, diagnosis, and treatment of VAP in adult burn patients. This guideline is designed to assist all healthcare providers caring for adult burn patients with suspected VAP. Summary recommendations were made using the following grading scale: grade A--supported by at least one well-designed prospective trial with clear-cut results; grade B--supported by several small prospective trials with a similar conclusion; and grade C--supported by a single small prospective trial, retrospective analyses, cases studies, and expert opinions based on investigators' practices.
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Randomized Controlled Trial
Efficacy of propranolol in wound healing for hospitalized burn patients.
Burn patients have the highest metabolic rate among critically ill or injured patients. Because propranolol decreases energy expenditure and muscle protein catabolism, in this study, we hypothesized that propranolol would improve healing process and decrease wound-healing time. This study was a double-blind randomized clinical trial; a total of 79 burn patients who referred to this center from January 2006 to January 2007 fulfilled the inclusion criteria. ⋯ Patients in the propranolol group had a shorter hospital stay period than the control group (30.95+/-8.44 days vs 24.41+/-8.11 days; P=.05). Administration of propranolol, improved burn wound healing, and decreased healing time and hospital stay period. The use of propranolol decreased the surface area of wounds that needed to be skin grafted.
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Burns to the upper extremity and axilla frequently result in the formation of contractures that can impede shoulder range of motion. The purpose of this study was to determine the long-term effects of upper extremity burn scar contracture release on motion during activities of daily living in the first year postrelease. Upper extremity motion analysis was conducted on children aged 4 to 17 years before and 1, 3, 6, and 12 months after axillary contracture release surgery. ⋯ Improvements were maintained for 1 year after surgery with majority of the improvement involving shoulder flexion. Axillary contracture release surgery improves functional shoulder mobility and decreases compensatory motions used during activities of daily living in the first year postrelease. Additional follow-up is needed to evaluate the impact of growth on scar development.
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The long-term effects of burn injuries can be devastating and last a lifetime. The aims of this study were to: (1) identify what factors adult burn survivors report as important during their burn recovery, (2) identify the frequency and reported benefits of peer support for burn survivors, (3) determine the difference in the level of reported hope among burn survivors who received peer support compared with survivors who did not receive peer support. ⋯ The t test scores for the two groups reflected the following: the group who received peer support (N=87) and the group who did not (N=28) showed a statistical significance for the Pathway Subscale [t=-2.197 (P=.030)] and the Total Hope Score [t=-1.971 and (P=<.050)]. The results of this survey suggest that there are perceived benefits of peer support and imply that peer support may have a positive impact on hope for burn survivors.