Journal of burn care & research : official publication of the American Burn Association
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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.
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Case Reports
Rehabilitation of speech and swallowing after burns reconstructive surgery of the lips and nose.
Rehabilitation of speech and swallowing postburns reconstructive surgery has not been previously described in detail in the literature. Severe facial burn injury requiring subsequent reconstructive surgery may result in complications including circumoral contracture and aesthetic and functional irregularities. These complications may manifest as facial and labial sensation deficits, poor oral access for intubation and oral/dental hygiene, and inadequate oral competence causing chronic drooling and poor articulation. ⋯ Speech pathology intervention aimed to 1) facilitate safe transition from nonoral to oral intake, 2) improve articulation and speech intelligibility, and 3) minimize oral contracture development. At 6 months postinjury, the patient can safely tolerate a soft diet, demonstrate speech clarity at preinjury level, and has recovered functional oral range of movement. Rehabilitation of speech and swallowing is an essential factor to consider when planning postburn reconstructive procedures.
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There are no guidelines to determine when bronchoscopy is appropriate in patients with inhalation injury complicated by pneumonia. We reviewed the National Burn Repository from 1998 to 2007 to determine if there is any difference in outcome in burn patients with inhalation injury and pneumonia who did and did not undergo bronchoscopy. Three hundred fifty-five patients with pneumonia did not undergo bronchoscopy, 173 patients underwent one bronchoscopy, and 96 patients underwent more than one bronchoscopy. ⋯ This benefit can be seen in a decreased duration of mechanical ventilation, decreased length of intensive care unit stay, and decreased overall hospital cost. In addition, there was a trend toward an improvement in mortality. The aggressive use of bronchoscopy after inhalation injury may be justified.
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Burn injury is associated with a significant leak of intravascular fluid into the interstitial space, requiring large amounts of volume resuscitation. Activation of the intrinsic (mitochondrial) apoptotic pathway has been associated with vascular hyperpermeability. We hypothesized that vascular hyperpermeability following burns is also mediated via this pathway. ⋯ Burn serum increased mitochondrial reactive oxygen species levels and reduced mitochondrial membrane potential; these effects were markedly reduced by (-)-deprenyl. Cytochrome c release was increased by treatment with burn serum (P<.05), and this effect was significantly inhibited by (-)-deprenyl (P<.05). Burn serum induces hyperpemeability and activates intrinsic apoptotic signaling in microvascular endothelial cells. (-)-Deprenyl, an antioxidant and antiapoptotic drug, modulates intrinsic apoptotic signaling and attenuates burn-induced hyperpermeability.
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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.