Burns : journal of the International Society for Burn Injuries
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Ventilation strategies aiming at prevention of ventilator-induced lung injury (VILI), including low tidal volumes (VT) and use of positive end-expiratory pressures (PEEP) are increasingly used in critically ill patients. It is uncertain whether ventilation practices changed in a similar way in burn patients. Our objective was to describe applied ventilator settings and their relation to development of VILI in burn patients. ⋯ This systematic review shows noticeable trends of ventilatory management in burn patients that mirrors those in critically ill non-burn patients. Variability in available ventilator data precluded us from drawing firm conclusions on the association between ventilator settings and the occurrence of VILI in burn patients.
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The objective of this study was to examine the thiol-disulfide profile tests in patients suffering from burn injuries. ⋯ There was a metabolic disturbance of the thiol-disulfide system among patients with burn injuries. The courses of thiol-disulfide variables in time overlapped with the burn mechanism. Strong associations provide that thiol-disulfide homeostasis might be a notable key for evaluating the severity of burns and predicting the survival.
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A correct estimation of total burn surface area is important since it is used for determining fluid resuscitation volumes, nutritional estimates and hospital admission criteria. Wallace's rule of nines is the most commonly used methods for this purpose. However, fat distribution is non-uniform and the total body surface area changes with obesity. The aim of this study was to determine if the rule of nines applies to all body mass index groups. ⋯ The Wallace rule of nines is a quick and acceptable method for estimating the total burn surface area percentage in men of all BMI ranges. However, for women, a more accurate method of burn area estimation is required as proposed by our BMI adjusted charts.
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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe adverse drug reactions with high mortality. The use of corticosteroids and the management of complications (e.g. infection) in SJS/TEN remains controversial. ⋯ The mortality of patients in this study was lower than that predicted by SCORTEN, although there was no significant difference between them. Hyperglycemia, high-dose corticosteroid, and the TBSA were closely related to the infections of patients with SJS/TEN.
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Observational Study
Resuscitation with albumin using BET formula keeps at bay fluid administration in burned patients. An observational study.
BET (Biological Engineering Technology) formula uses fluids with high albumin concentration to resuscitate burn patients. It estimates fluid resuscitation as a function of Body Burned Surface Area (BBSA) (ml/h = BBSA (m2) × 220) and administers it through a combination of lactated ringer and 20% Albumin starting at a 1:1 relationship. The proportion of albumin is decreased every 8 h, and infusion rate is modified according to urinary output. ⋯ Patients were successfully resuscitated showing a significant base excess increase and lactate clearance during the resuscitation period (base excess 120%; lactate 29%; P < 0.05). Burn related complications where: ARDS 27%, renal dysfunction 53%, wound deepening 20%, abdominal compartment syndrome 4.5%. In conclusion, BET formula is capable of resuscitating burn patients successfully, limiting fluid administration.