Journal of burn care & research : official publication of the American Burn Association
-
Severe burn injury results in a multifaceted physiological response that significantly alters drug pharmacokinetics and pharmacodynamics (PK/PD). This response includes hypovolemia, increased vascular permeability, increased interstitial hydrostatic pressure, vasodilation, and hypermetabolism. These physiologic alterations impact drug distribution and excretion-thus varying the drug therapeutic effect on the body or microorganism. ⋯ Dosing techniques must be adapted based on burn injury-related changes in PK/PD parameters in order to ensure drug efficacy. Although several PK/PD studies have been undertaken in the burn population, there is wide variation in the analytical techniques, software, and study sample sizes used. In order to refine dosing techniques in burns and consequently improve patient outcomes, there must be harmonization among PK/PD analyses.
-
The term "functional" in burn rehabilitation has gained widespread use to describe a patient's recovery after burn injury. But what truly is "functional" when applied to a patient recovering from burn injury? A literature search was performed for information defining "functional" range of motion (ROM). Maximum upper and lower ROM values to perform a variety of daily activities were abstracted and compared with published outcomes of patient groups recovered from burn injury. ⋯ In comparing the results, many burn survivors with severe burn scar contractures could be considered "functional." Refinement of the term "functional" is needed related to burn outcomes. Functional ROM of a particular joint to perform one specific task may be insufficient to perform a variety of other tasks when all planes of motion are considered. Use of the term "functional" to describe a patient's outcome should be used in a guarded manner.
-
After a burn injury, superficial partial-thickness burn wounds may progress to deep partial-thickness or full-thickness burn wounds, if kept untreated. This phenomenon is called secondary burn wound progression or conversion. Burn wound depth is an important determinant of patient morbidity and mortality. ⋯ Warm water, simvastatin, EPO, or cerium nitrate may represent particularly promising approaches for the translation into clinical use in the near future. This review demonstrates promising experimental approaches that might reduce secondary burn wound progression. Nevertheless, a translation into clinical application needs to confirm the results compiled in experimental animal studies.
-
The main objective of the present study was to examine whether self-inflicted burn patients would differ from nonintentional, nonwork related burn patients on psychiatric and personality characteristics. Sociodemographic and injury related factors were also compared. Self-inflicted (N = 15) and nonintentional (N = 178) burn patient samples were drawn from a larger study examining physical and psychosocial outcomes following major burn. ⋯ There were no differences on TBSA (P = .52) or sociodemographic characteristics (P values > .08). Relative to survivors of nonintentional burns, self-inflicted burn patients in the United States demonstrate high psychiatric comorbidity. Standards of care must be developed to optimize treatment procedures and recovery outcomes in this subgroup.
-
Severe burn injury has been shown to result in hypophosphatemia. Hypophosphatemia can cause cardiac, hematologic, immunologic, and neuromuscular dysfunction. This study compares serum phosphate levels and outcomes in patients who were administered a continuous, preemptive phosphate repletion protocol vs those who only received phosphate supplementation after they developed hypophosphatemia. ⋯ Continuous, pre-emptive repletion of phosphate prevents hypophosphatemia after severe burn injury when compared with responsive repletion in historical controls. The protocol resulted in less hypophosphatemia without increasing the risk of hyperphosphatemia. This study also suggests that continuous repletion may result in fewer complications, but this needs to be confirmed in larger, prospective studies.