Burns : journal of the International Society for Burn Injuries
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Three factors that effect burn mortality are age, total body surface of burn (TBSA), and inhalation injury. Of the three, inhalation injury is the strongest predictor of mortality thus its inclusion in the revised Baux score (age+TBSA+17* (inhalation injury, 1=yes, 0=no)). However, the weighted contribution of specific comorbidities such as smoker status on mortality has traditionally not been accounted for nor studied in this subset of burn patients. We therefore sought to examine the impact of current tobacco and/or marijuana smoking in patients with inhalation injury. ⋯ In the sub group of burn patients with inhalation injury, the odds of mortality significantly decreased in pre-existing smokers after adjusting for significant covariates. We postulate that an immune tolerance mechanism that modulates and diminishes the pro-inflammatory response confers a survival advantage in smokers after exposure to acute smoke inhalation injury. Future prospective studies in human and/or animal models are needed to confirm these findings.
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To describe the experience of distributing 499 burn casualties of an unexpected event and determine whether patient transfer is associated with patient outcomes measured 2 weeks after the incident. ⋯ In case of inadequate burn centers, satisfactory patient outcomes can be achieved by the immediate treatment of patients, despite the treating hospitals being lower-level hospitals. Regardless of the hospital level, immediate treatment of burn patients is crucial to reducing mortality.
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Explosion injury is very common on the battlefield and is associated with major burn and inhalation injuries and subsequent high mortality and morbidity rates. Here we report six victims who suffered from explosion injuries caused by stun grenade; all were treated with extracorporeal membrane oxygenation (ECMO) as salvage therapy. This study was aimed to evaluate the indications and efficacy of ECMO in acute and critically ill major burn patients. ⋯ In acute and critically ill major burn patients, ECMO could be considered as a salvage therapy, particularly in those with inhalation injury and burn-related acute respiratory distress syndrome. However, ECMO does not seem to provide benefits for circulatory support in those with hemodynamic compromise. The use of ECMO in these patients is still investigational, as our data provided no benefit in terms of the outcomes or survival, particularly in those with more than 90% TBSA burns.
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Randomized Controlled Trial
Internet-based information and support program for parents of children with burns: A randomized controlled trial.
The aim of the study was to evaluate the feasibility and effects of an internet-based information and self-help program with therapist contact for parents of children and adolescents with burns. The program aimed to reduce parents' symptoms of general and posttraumatic stress. ⋯ The program has the potential to support parents of children with burns. The intervention is easily accessible, cost-effective and could be implemented in burn care rehabilitation.
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The back is a challenging anatomical area to resurface in acute burns due to its large surface area, its dependent position with the patient lying down and the shearing forces applied to any method of resurfacing employed. This case study presents the use of Vivostat(®) (Vivostat A/S, Lillerød, Denmark) in resurfacing the back in conjunction with Recell(®) regenerative epithelial suspension. Vivostat(®) (Vivostat A/S, Lillerød, Denmark) is a "novel patented biotechnological process that enables reproducible preparation of autologous fibrin sealant or platelet rich fibrin without cryoprecipitation or a separate thrombin component" [1]. ⋯ NICE (The National Institute for Health and Care Excellence) states that Recell(®) shows potential to improve healing in acute burns and we believe that its co-delivery with fibrin via Vivostat(®) (Vivostat A/S, Lillerød, Denmark) allows for precise delivery of the fibrin suspended cells while minimising loss in the "run off" encountered when Recell(®) is just simply sprayed on, assisting the anchoring of keratinocytes to the wound surface and thus aiding in the treatment of challenging areas.