The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Sep 1992
Randomized Controlled Trial Clinical TrialA distraction technique for control of burn pain.
Research has indicated that analgesics alone do not adequately relieve pain for 75% of patients with burns. The purpose of this study was to determine the effects of a distraction therapy, in which videos were used in combination with administration of analgesics, on intensity and quality of pain and on levels of anxiety in adults during burn dressing changes. The sample consisted of 17 patients who were randomly assigned to the treatment or the control group. ⋯ Each was asked to score his or her present pain intensity and pain rating index with the McGill questionnaire and anxiety with the Spielberger questionnaire before and after the dressing change. A nested general linear model using the "F" test in multiple regression analysis was adjusted for age, percent partial-thickness burn, and choice of topical agent demonstrated that the use of videos during the dressing changes significantly reduced pain and anxiety: present pain intensity (F = 8.69; p = 0.01), pain rating index (F = 5.57; p = 0.03), anxiety (F = 9.10; p = 0.01). It is recommended that the use of pain medication be augmented by use of videos during burn dressing changes.
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J Burn Care Rehabil · Sep 1992
Comparative StudyDecreased pulmonary barotrauma with the use of volumetric diffusive respiration in pediatric patients with burns: the 1992 Moyer Award.
Pulmonary barotrauma is a frequent, life-threatening complication in the pediatric patient who is treated with mechanical ventilation. The volumetric diffusive respiration (VDR) ventilator, which employs a high-frequency progressive accumulation of subtidal volume breaths in a pressure-limited format with a percussive waveform, is capable of providing adequate gas exchange at lower airway pressures; this theoretically decreases the incidence of pulmonary barotrauma compared with conventional mechanical ventilation (CV). The incidence of pulmonary barotrauma since 1988 was evaluated in pediatric patients with burns who were younger than 2 years of age. ⋯ Pulmonary barotrauma was defined as the development of pneumothorax, pneumomediastinum, pneumopericardium, or pneumoperitoneum. There were no significant differences between CV-treated and VDR-treated groups (mean +/- SEM) in the patient characteristics of age (15.9 +/- 1.3 months vs 16.6 +/- 1.8 months), weight (11.2 +/- 0.5 kg vs 12.5 +/- 0.7 kg), percent total body surface burn (46.2% +/- 4.9% vs 55.6% +/- 6.2%), percent full-thickness burn (38.1% +/- 5.3% vs 50.0% +/- 6.6%), inhalation injury (40% vs 60%), or total number of days that mechanical ventilation was required (18.2 +/- 4.2 days vs 22.4 +/- 5.9 days); although these parameters show a slightly more severe degree of injury in the VDR-treated group. There was a reduction in the incidence of pulmonary barotrauma when VDR was used.(ABSTRACT TRUNCATED AT 250 WORDS)
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J Burn Care Rehabil · Sep 1992
Clinical Trial Controlled Clinical TrialClinical trials of a living dermal tissue replacement placed beneath meshed, split-thickness skin grafts on excised burn wounds.
We evaluated the ability of Dermagraft (Advanced Tissue Sciences, La Jolla, Calif.), a living tissue analog that is composed of human neonatal fibroblasts, which are grown on a polyglactin acid Vicryl mesh (Ethicon Inc., Somerville, N. J.), to function as a dermal replacement when placed beneath meshed, expanded split-thickness skin grafts (MESTSGs). Full-thickness burn wounds in 17 patients with burns (mean age, 31 years; range, 6 to 69 years; mean burn size, 23.8% total body surface area) were excised to subcutaneous fat (nine patients), to fascia (three patients), or to a combination of deep dermis and fat (five patients). ⋯ The Vicryl fibers were hydrolyzed in the wound over a 2-to-4-week period, although some expulsion of fibers occurred as the healing epithelium advanced to close the MESTSG interstices. Elastic fibers were not seen in neodermal tissue in either control or experimental wounds at periods of up to 1 year after grafting. Further trials with this living tissue replacement are in progress.
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Modern burn care often leads to the dilemma of what should or should not be done for patients with clinical deterioration and organ system failure who fail to respond to therapy. The questions are, "When is enough enough?" and "Who decides?" We have developed a structured conference to address these issues and to help us decide whether to recommend continued invasive diagnostic and therapeutic intervention or to allow the patient to "die with dignity." This conference can be requested by any member of the burn team who feels uncomfortable with what is being done for and/or to a patient. It is a meeting of the entire team, and its purpose is to discern the judgment of the group. ⋯ The family often experiences a great deal of relief, because they are not forced to make the decision even though they wanted it made. Inviting nurses to be active participants in the decision process builds their personal and professional self-esteem and binds the team members into a more tightly knit community. The attending staff may perceive this process as an abdication of responsibility; however, in our experience the consensus conference has led to a conviction that the wisdom of the team is always best.
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J Burn Care Rehabil · Sep 1992
Mixing inpatient with outpatient care: establishing an outpatient clinic on a burn unit.
Outpatient care of patients with burns is an important aspect of a total health care plan. Changes in the health care system, which focuses on cost containment, force reevaluation of the methods used for delivery of high-tech care, particularly in areas such as burn care. Great advances that have taken place over the past decade in the field of burn care have enabled health care providers to treat more patients with burns as outpatients. ⋯ Several obstacles needed to be overcome before an outpatient clinic could be established on the burn unit itself. Wound care is now provided by burn unit nurses, which leads to better results and more consistent follow-up. Patient satisfaction is increased, patient teaching is provided by experienced staff, unnecessary admissions are prevented, and patients are able to be discharged from the hospital earlier or to be followed as outpatients even if surgery is eventually required.