Journal of burn care & research : official publication of the American Burn Association
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Comparative Study
The Combination of SAT and SBT Protocols May Help Reduce the Incidence of Ventilator-Associated Pneumonia in the Burn Intensive Care Unit.
There are few published reports on the unique nature of burn patients using a paired spontaneous awakening and spontaneous breathing protocol. A combined protocol was implemented in our burn intensive care unit (ICU) on January 1, 2012. This study evaluates the impact of this protocol on patient outcomes in a burn ICU. ⋯ Among patients with inhalation injuries, the protocol group exhibited fewer ventilator and ICU days. Protocol implementation in a burn ICU was accompanied by decreased ventilator days and a reduced incidence of pneumonia. A combined spontaneous awakening and breathing protocol is safe and may improve clinical practice in the burn ICU.
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The systemic responses triggered by burns have been shown to include effects on the gastrointestinal tract. However, it is not clear if these changes lead to long-term gastrointestinal morbidity in patients with burns. The aim of this study was to assess if pediatric burns are associated with increased hospital use for gastrointestinal diseases after discharge for the initial injury. ⋯ Negative binomial and Cox proportional hazards regression modeling were used to generate incidence rate ratios (IRRs) and hazard ratios, respectively. After discharge, the pediatric burn cohort experienced twice the rate of gastrointestinal disease admissions (IRR, 95% confidence interval [CI]: 2.03, 1.56-2.65), spent over twice as long in hospital (IRR, 95% CI: 2.23, 1.67-2.98), and had a higher rate of first-time or incident gastrointestinal disease admissions (hazard ratio, 95% CI: 1.18, 1.08-1.29) when compared with the uninjured cohort, after adjusting for demographic and preexisting health factors. Children who experience a burn injury hospitalization are at increased risk of postburn hospital service use for gastrointestinal diseases when compared with uninjured children.
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Multicenter Study
Quantifying Risk Factors for Long-Term Sleep Problems After Burn Injury in Young Adults.
Restorative sleep is an important component of quality of life. Disturbances in sleep after burn injury were reported but all based on uncontrolled or nonstandardized data. The occurrence and the effect of long-term sleep problems in young adult burn survivors have not been well defined. ⋯ Lower satisfaction with sleep is associated with poorer scores in nearly all quality of life measures. Satisfaction with sleep should be addressed during the long-term clinical follow-up of young adults with burn injuries. Further research should be undertaken to understand the components of sleep quality that are important to burn survivors and which ones might be modified and tested in future intervention studies.
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Comparative Study
Does Overestimation of Burn Size in Children Requiring Fluid Resuscitation Cause Any Harm?
Overestimation of burn size especially in children is common. It is unclear if this may cause harm. This study was designed to assess the accuracy of burn size estimation by referring non-burn clinicians and investigate whether inaccurate estimates caused any harm. ⋯ None of these children went on to have any significant complications as a result of overestimation. Training and education is essential for clinicians in emergency departments. However, estimation of size in pediatric burns, in particular scalds, is challenging and the importance of early transfer to a specialist service cannot be overemphasized.
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Randomized Controlled Trial Comparative Study
Randomized, Paired-Site Comparison of Autologous Engineered Skin Substitutes and Split-Thickness Skin Graft for Closure of Extensive, Full-Thickness Burns.
Stable closure of full-thickness burn wounds remains a limitation to recovery from burns of greater than 50% of the total body surface area (TBSA). Hypothetically, engineered skin substitutes (ESS) consisting of autologous keratinocytes and fibroblasts attached to collagen-based scaffolds may reduce requirements for donor skin, and decrease mortality. ESS were prepared from split-thickness skin biopsies collected after enrollment of 16 pediatric burn patients into an approved study protocol. ⋯ These values were significantly different between the graft types. Correlation of % TBSA closed with ESS with % TBSA full-thickness burn generated an R value of 0.65 (P < .001). These results indicate that autologous ESS reduce mortality and requirements for donor skin harvesting, for grafting of full-thickness burns of greater than 50% TBSA.