Burns : journal of the International Society for Burn Injuries
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Once-daily aminoglycoside dosing (ODA) is used in most patient populations to optimize antibacterial activity and reduce toxicity. Unfortunately, burn patients are excluded from ODA due to concerns over altered pharmacokinetics resulting in a shortened half-life and low peak aminoglycoside concentrations. Retrospective studies suggest that ODA may be appropriate if higher milligram/kilogram doses are used. However, no prospective clinical trials in burn patients exist to confirm these findings. ⋯ Burn patients with adequate renal function and <20% TBSA are candidates for ODA. Tobramycin half-life was similar to healthy, non-burn patients. The larger than normal volume of distribution supports the use of the higher empiric dose of 10mg/kg total body or adjusted weight in non-obese and obese patients, respectively, with further dose adjustment based on therapeutic drug monitoring.
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Methylene blue reduces progression of burn and increases skin survival in an experimental rat model.
Following burn, increased nitric oxide (NO) combine with superoxide anion forming peroxynitrite. Methylene blue (MB) has NO blocking and antioxidant effects. Male Wistar rats (250g) were burned bilaterally in dorsum with a comb metal plate heated inside boiling water and applied during 30s, creating four rectangular 10×20mm full-thickness burned areas separated by three 5×20mm unburned interspaces (stasis zone). 30 rats were randomized into three groups (n=10): treated groups received one dose of intraperitoneal (IP) MB injections (2mg/kg), one or six hours after injury, and control group received saline. ⋯ Interspace's NOx increased in both MB groups (P=0.0130) with no difference in burned areas. No MDA difference was observed. IP MB injection one or six hours after injury reduced necrosis progression in stasis area in the rat comb burn model suggesting an antioxidant effect reducing oxidative stress.
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Burn injury is common and depth is one measure of severity. Although the depth of burn injury is determined by many factors, the relationship between the temperature of the injurious agent and exposure duration, known as the time-temperature relationship, is widely accepted as one of the cornerstones of burn research. Moritz and Henriques first proposed this relationship in 1947 and their seminal work has been cited extensively. However, over the years, readers have misinterpreted their findings and incorporated misleading information about the time-temperature relationship into a wide range of industrial standards, burn prevention literature and medicolegal opinion. ⋯ Time-temperature relationships established for pain and superficial dermal burns in adult human skin have an extensive experimental modeling basis and reasonable clinical validation. However, time-temperature relationships for subdermal burns, full thickness burns and burn injury in children have limited clinical validation, being extrapolated from other data, and should be used with caution, particularly if presented during expert evidence.
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Early excision of burns reduces the incidence of local and systemic infections caused by colonising microorganisms, and reduces mortality and length of hospital stay. Appropriate antibiotic prophylaxis can reduce the risk of postoperative wound infections and skin graft loss. Antibiotic selection should be based on likely pathogens. However, there are few studies that have investigated the early pathogenic colonisers of acute burn wounds. ⋯ Increased colonisation of acute burn wounds with pathogenic gram-negative bacteria was associated with increased size of burn.