The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Jul 1989
Randomized Controlled Trial Comparative Study Clinical TrialIncreased mortality with intravenous supplemental feeding in severely burned patients.
Patients with large cutaneous burns are characterized by an elevated metabolic rate and lose up to 25% of their body weight within 3 weeks. A previous study suggested that intravenous supplementation to attain nutritional requirements was of no benefit in patients with cutaneous burns covering greater than 50% of their total body surface area. In this study 39 patients with burns greater than 50% of their total body surface area were randomly assigned to receive intravenous supplementation of enteral calories (n = 16) or enteral calories alone (n = 23). ⋯ T cell helper/suppressor ratios were depressed in both groups when compared with controls; however, the intravenously supplemented group was significantly depressed at 7 to 14 days after burn. Both groups demonstrated hepatomegaly, moderate fatty infiltration, and cholestasis. It is suggested that intravenous supplementation should be carefully evaluated and used only in patients with total enteral failure.
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J Burn Care Rehabil · Jul 1989
Computer simulation of fluid resuscitation in trauma. First pragmatic validation in thermal injury.
A comprehensive pathophysiologic model has been designed to describe the fluid shifts and hemodynamics in connection with fluid therapy for patients who have had trauma. The model is used to simulate treatment of a patient with burn injury, and these results are compared with measured physiologic and biochemical variables. Various formulas for resuscitation of patients with thermal injuries are also simulated to illustrate the potential use of the "patient simulator" for designing fluid resuscitation programs.
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Reducing blood flow to the skin during burn wound excision should decrease blood loss, which remains a major problem during primary excision of large burns. This clinical investigation demonstrates that arginine-vasopressin appears to reduce intraoperative blood loss and is relatively free of complications. This treatment has potential benefits for the patient with small burns as well. The amount of banked blood required could be greatly reduced, thus decreasing the risks of transfusion and the cost of burn care.
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J Burn Care Rehabil · Jul 1989
Use of Pseudomonas hyperimmunoglobulin to treat septic shock in burn cases.
The progress of 18 episodes of septic shock in nine patients with burn injuries after administration of a Pseudomonas immunoglobulin is presented. In nine instances the septic shock was treated successfully. The mean burn index of these nine patients was 96. ⋯ Despite the different causative agents, successful treatment was possible in these cases. The mean burn index for the four patients who eventually died was 119; all patients in this group were suffering from an inhalation trauma and acute kidney failure requiring dialysis. In these cases even the use of Pseudomonas immunoglobulin had no decisive effect.