Journal of burn care & research : official publication of the American Burn Association
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Extracorporeal membranous oxygenation (ECMO) has become an increasingly utilized used strategy to support patients in cardiac and cardiopulmonary failure. The Extracorporeal Life Support Organization reports adult survival rates between 40 and 50%. Utilization Use and outcomes for burned patients undergoing ECMO are poorly understood. ⋯ Ventilator usage, intesive care unit (ICU) length of stay, and mortality were also significantly higher in those treated by ECMO (P < .05). Although burn patients placed on ECMO have significantly higher rates of morbidity and mortality than those not requiring ECMO, the mortality rate is equivalent to patients reported by Extracorporeal Life Support Organization. ECMO is a viable option for supporting critically injured burn patients.
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Review
Pain Management in Pediatric Burn Patients: Review of Recent Literature and Future Directions.
Childhood burns are a profoundly traumatic and painful experience. Despite recognition of the prevalence of burn injuries in children and the severity of the associated pain, burn pain remains undertreated. At the same time, more evidence is emerging to suggest that undertreated pain has serious long-term medical and psychiatric consequences, many of which can be ameliorated with improved pain control. ⋯ However, because clinical investigations remain limited in burned children, we also aim to draw attention to those areas where the data do not identify an optimal approach and further work is needed. Overall, in addition to just the traditional pharmacological approaches to pain, such as acetaminophen, benzodiazepines, and opioids, there is growing evidence to support more widespread use of regional anesthesia and novel technologies such as virtual reality. Starting with an improved understanding of the current state of the literature, we can identify areas of research and important questions whose answers will ultimately improve care and reduce suffering for this unfortunate population of children.
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Randomized Controlled Trial
Safety of Nebulized Epinephrine in Smoke Inhalation Injury.
This pilot study was conducted to profile safety of nebulized racemic epinephrine when used as a therapy for smoke inhalation injury in severely burned children. We enrolled 16 patients who were 7 to 19 years of age ([mean ± SD], 12 ± 4 years) with burns covering more than 30% of the TBSA (55 ± 17%) and smoke inhalation injury, as diagnosed by bronchoscopy at burn center admission. Patients were randomized to receive either standard of care (n = 8), which consisted of nebulized acetylcysteine, nebulized heparin, and nebulized albuterol, or to receive standard of care plus nebulized epinephrine (n = 8). ⋯ The groups did not significantly differ with regard to age, sex, burn size, days on ventilator, pulmonary function, or cardiopulmonary fitness. Results of this pilot trial indicate epinephrine to be safe when administered to pediatric burn patients with smoke inhalation injury. Current data warrant future efficacy studies with a greater number of patients.
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Burn injuries have economical impacts on patients in several ways. Understanding the charges of burn treatment is very important for patients, families, governmental authorities, and insurance companies. During the protocol of their treatment, they may be admitted several times for treatment of acute burn and then for reconstructive treatments of burn's complications. ⋯ But "age" did not influence the charges. Mean total cost of several burn admissions in one patient was around $2766. TBSA, length of stay, male sex, and number of admissions were significantly related to the hospital costs.
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This study was aimed to explore the level of psychological distress and posttraumatic stress among female burn survivors in Pakistan. It was also intended to study the kind of social support available to these burn survivors in a society where women right violation is common. The sample consisted of 35 female burn victims selected from two hospitals. ⋯ There was a significant inverse relationship between psychological reactions and social support as hypothesized. Majority of female burn victims found to use emotion-focused coping (EFC) mainly including prayers, emotional discourse, and using drugs. The findings of the study would be helpful to plastic surgeons, dermatologists, psychologists, and social workers to understand the patient's psychological reactions, their copying styles, and the role of social support in the rehabilitation program for these survivors.