Burns : journal of the International Society for Burn Injuries
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Burns incidence, mortality and complication rates have been shown to be directly correlated by race, gender and socioeconomic status. As such, socioeconomic status (SES) has been previously highlighted as a target for burn prevention in the UK and abroad. The Queen Elizabeth Hospital, Birmingham (QEHB) is the regional Burns Centre for the Midlands Burn Network, supporting a population of 13.7 million METHODS: 16-year retrospective review was performed of all acute adult burns assessed by the Burns and Plastics Department, QEHB. The data included patient demographics (age, gender, ethnic origin and postcode), mechanism of injury, total body surface area (TBSA) affected and whether first aid was given. IMD Rank, IMD Scores were obtained from individual postcodes, as well as incidence data per electoral ward. ⋯ This study shows patients from the most deprived areas are over-represented in burns incidence and are less likely to perform first aid. We feel this should be highlighted in burns prevention and education strategies.
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Traditionally, lactated Ringer's solution (LR) has been utilized for the resuscitation of thermally injured patients via the Parkland or Brooke formulas. Both of these formulas include colloid supplementation after 24 h of resuscitation. Recently, the addition of albumin within the initial resuscitation has been reported to decrease fluid creep and hourly fluids given. Our institution has previously advocated for a crystalloid-driven resuscitation. Given reports of improved outcomes with albumin, we pragmatically adjusted these practices and present our findings for doing so. ⋯ Rescue albumin administration decreases the amount of fluid administered per %TBSA during resuscitation, and also increases end organ function as evidenced by increased urinary output. These effects occurred in patients who sustained larger burns and failed to respond to traditional crystalloid resuscitation. Our findings led us to modify our current protocol and a related prospective study of clinical outcomes.
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Burn fluid resuscitation guidelines have not specifically addressed mass casualty with resource limited situations, except for oral rehydration for burns below 40% total body surface area (TBSA). The World Health Organization Technical Working Group on Burns (TWGB) recommends an initial fluid rate of 100 mL/kg/24 h, either orally or intravenously, beyond 20% TBSA burned. We aimed to compare this formula with current guidelines. ⋯ The TWGB formula for mass burn casualties may enable appropriate fluid resuscitation for most salvageable burned patients in disasters. This simple formula is easy to implement. It should simplify patient management including transfers, reduce the risk of early complications, and thereby optimize disaster response, provided that tailored resuscitation is given whenever specialized care becomes available.
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Observational Study
Quantification of the negative impact of sedation and inotropic support on achieving early mobility in burn patients in ICU: A single center observational study.
Early rehabilitation for burns survivors in the intensive care unit (ICU) is arguably more challenging than the general population. Early achievement of functional verticality milestones (FVMs) has the potential to ameliorate the detrimental effects of bed rest and immobility observed in ICU patients and reduce healthcare costs. However, the time to achieving FVMs after burn injury is influenced by factors such as sedation practices, cardiovascular stability, mechanical ventilation, acute skin reconstruction and length of stay (LOS) during the acute intensive care period. ⋯ Maintaining sedation and agitation scores within the optimal range, and minimising sedative infusion and inotropic support enhances the likelihood of early and frequent mobilization in patients with burns admitted to ICU. Additional barriers identified were mechanical ventilation, burns surgery, pre-ICU practices and ICU length of stay. The challenge for clinicians moving forward is to determine how these factors may be modified to increase early mobilization of burn patients in ICU.