Journal of burn care & research : official publication of the American Burn Association
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The rate of wound healing and its effect on mortality has not been well described. The objective of this article is to report wound healing trajectories in burn patients and analyze their effects on in-hospital mortality. The authors used software (WoundFlow) to depict burn wounds, surgical results, and healing progression at multiple time points throughout admission. ⋯ For H patients, median DAYS was 41 (28-54); median DAYS/TBSA was 1.3 (1.0-1.9). Survivors had a 0.62% drop in OWS/day, or 4.3%/week. In this cohort of patients with ≥ 20% TBSA, there was a difference in mortality after postburn day 20, between patients with a positive healing rate (+2%/day, 100% survival) and those with a negative healing rate (-2%/day, 100% mortality, P < .05).
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Peripherally inserted central line catheter (PICC) use has increased in burn patients. While the risks of central line associated blood stream infections (CLABSI) in burn patients have been well studied, the risks of PICC infections have yet to be fully elucidated. A retrospective chart review was performed of all burn patients with a PICC admitted to our regional burn center from 2006 to 2008. ⋯ On multivariate analysis, TBSA (Odds ratio [OR] = 1.05*), length of admission (OR = 1.04*), and hospital day of PICC insertion (OR = 1.05*) all independently increased the risk of developing a PICC infection. Patients with severe burn injury, long hospital admissions, and later hospital day of PICC insertions are at higher risk of developing PICC infections. This data suggests that protocols should be developed about routine PICC changes in this high-risk burn population.
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Accurate burn depth estimation remains one of the foundations of optimal burn care. The method by which burn depth is determined has traditionally been clinical examination alone. This continues to hold true in the United States, despite a plethora of literature supporting the use of more accurate modalities such as laser Doppler imaging (LDI). ⋯ The top three modalities ranked as "most promising" for daily use were clinical examination, LDI, and noncontact/high-frequency ultrasound. Directors identified the top three limitations to the use of new technology as cost (72%), availability (63%), and lack of support by evidence to date (35%). Future studies may need to focus on overcoming these perceived limitations before the widespread use of LDI or other new modalities will be realized at burn centers in the United States.
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Opioids like morphine form the mainstay of treatment for moderate to severe burn pain. However, lack of dedicated burn care service and potentially serious side effects of opioids often compromise effective treatment. Newer drugs as well as newer routes of administration of analgesic drugs are long-felt needs in the management of burn pain. ⋯ The analgesic effect of HOE 140 was locally mediated. Healing of the wound was normal. In conclusion, the results suggest that bradykinin type 2 receptor antagonists such as HOE 140 could be useful in the treatment of acute inflammatory pain.