Annals of burns and fire disasters
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Ann Burns Fire Disasters · Dec 2015
Pre-burn centre management of the airway in patients with face burns.
Face burns expose patients to a higher respiratory risk, and early prophylactic intubation before they enter the burn unit might be life-saving. However, unnecessary intubation may compromise their clinical evolution. Hence, the decision to perform pre-burn centre endotracheal intubation remains a clinical challenge. ⋯ A face burn is a warning sign of a possible upper airway injury, and pre-burn centre prophylactic intubation might be life-saving. However, unnecessary intubation may impair clinical evolution. Therefore, it is imperative that updated practice guidelines for pre-burn centre airway management are adhered to, and that these guidelines are subject to revision in order to improve airway management in burn patients.
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Self-inflicted burns (SIB) consistently account for a small proportion of burn injuries. There is a wide spectrum of SIB, from minor burns through to major life threatening burn injuries in suicidal patients who have committed self-immolation. Non-fatal deliberate self-harm (DSH) is a common reason for presenting to hospital. ⋯ In the majority of cases (85%) another admission preceded the presentation to our service with SIB. Only four out of the 17 SIB patients (24%) who died of their injuries had previous hospital admissions with DSH. This lends weight to the need for thorough holistic assessment of any patient admitted to hospital with sequelae of deliberate self-harm in order to try and provide appropriate support and interventions for these vulnerable individuals to prevent recurrent self-harm or suicide.
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Ann Burns Fire Disasters · Sep 2015
Implementation of a procalcitonin-guided algorithm for antibiotic therapy in the burn intensive care unit.
The purpose of this study was to examine the hypothesis that an algorithm based on serial measurements of procalcitonin (PCT) allows reduction in the duration of antibiotic therapy compared with empirical rules, and does not result in more adverse outcomes in burn patients with infectious complications. All burn patients requiring antibiotic therapy based on confirmed or highly suspected bacterial infections were eligible. Patients were assigned to either a procalcitonin-guided (study group) or a standard (control group) antibiotic regimen. ⋯ In 24 patients antibiotic therapy was guided by daily procalcitonin and clinical assessment. PCT guidance resulted in a smaller antibiotic exposure (10.1±4 vs. 15.3±8 days, p=0.034) without negative effects on clinical outcome characteristics such as mortality rate, percentage of patients with relapse or superinfection, maximum SOFA score, length of ICU and hospital stay. The findings thus show that use of a procalcitonin-guided algorithm for antibiotic therapy in the burn intensive care unit may contribute to the reduction of antibiotic exposure without compromising clinical outcome parameters.
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Ann Burns Fire Disasters · Jun 2015
Procalcitonin: a diagnostic and prognostic biomarker of sepsis in burned patients.
The goal of this study was to analyse plasma procalcitonin (PCT) concentrations during infectious events of burns in ICU. We conducted a prospective, observational study in a 20-bed Burn Intensive Care Unit in Tunisia. A total of 121 patients admitted to the Burn ICU were included in our study. ⋯ Patients were assigned to two groups depending on the clinical course and outcome: Group A = non septic patients; Group B = septic patients. A PCT cutoff value of 0,69 ng/ml for sepsis prediction was associated with the optimal combination of sensitivity (89%), specificity (85%), positive predictive value (82%) and negative predictive value (88%). Serum procalcitonin levels can be used as an early indicator of septic complication in patients with severe burn injuries as well as in monitoring the response to antimicrobial therapy.
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Ann Burns Fire Disasters · Jun 2015
Progress in burns research: a review of advances in burn pathophysiology.
Severe burns trigger a wide range of responses in the victim. Initial vascular changes are followed by hypermetabolic, inflammatory and immunologic changes. The prolonged hypermetabolic response is associated with an elevated resting rate of energy consumption, tissue wasting and altered substrate kinetics. ⋯ Some clinical areas in which treatment centred on correcting altered physiology were also included. We have highlighted both the challenges and significant findings. Finally, this paper draws attention to the gaps between progress in basic research and clinical application and suggests areas where further research and funding could be focused.