Journal of burn care & research : official publication of the American Burn Association
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The current Australian and New Zealand Burn Association (ANZBA) recommended Burns First Aid Treatment is place the burn under cool running water for 20 minutes. Wet towels and water spray also have been used frequently. No scientific data exist to compare the effectiveness of these methods of cooling. ⋯ The outcomes with wet towels and water spray were variable. Cool running water consistently demonstrated improvement in wound recovery over the course of 9 days (P < .05). This study demonstrated that cool running water appeared the most effective first aid for an acute scald burn wound in a porcine model compared with wet towels and water spray.
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Randomized Controlled Trial Multicenter Study
Comparison of fibrin sealant and staples for attaching split-thickness autologous sheet grafts in patients with deep partial- or full-thickness burn wounds: a phase 1/2 clinical study.
We undertook a multicenter, randomized, controlled, phase 1/2 clinical study to investigate the safety and efficacy of a fibrin sealant containing 4 IU/ml thrombin (FS 4IU) for the attachment of autologous sheet grafts in patients with deep partial-thickness or full-thickness burn wounds. Fibrin sealant (FS 4IU) was compared with staples for adherence of sheet grafts in 40 patients. Patients had to have burn wounds measuring 40% TBSA or less with two comparable test sites measuring between 1% and 4% TBSA each. ⋯ The safety profile of FS 4IU was excellent as indicated by the lack of any related serious adverse experiences. These findings indicate that FS 4IU is safe and effective for fixation of skin grafts, with outcomes similar to or better than staple fixation. The data suggest that FS 4IU is a promising candidate for further clinical studies focusing on skin graft adhesion and burn wound healing.
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Inhalation injury causes significant morbidity and mortality, accounting for nearly 80% of non-fire-related deaths and affecting nearly 25% of all patients hospitalized with thermal injury. High-frequency percussive ventilation (HFPV) has been reported to decrease both the incidence of pulmonary barotrauma and pneumonia in inhalation injury. It has evolved into a ventilatory modality promoted to rapidly remove airway secretions and improve survival of patients with smoke inhalation injury. ⋯ Twenty-six of 92 (28%) patients treated with HFPV, and 56 of 130 with conventional mechanical ventilation (43%) died. There was a significant decrease in both overall morbidity and mortality in the subset of patients with < or = 40% TBSA treated with HFPV. Future randomized, controlled trials are needed to determine the precise role of HFPV in the treatment of inhalation injuries.
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The Vancouver Scar Scale is too subjective for our needs and is not culturally sensitive to our Aboriginal clients. The VSS was modified by developing a color scale to aid with vascularity rating. This study was designed to measure the inter-rater reliability of the modified Vancouver Scar Scale (MVSS). ⋯ Because the pigmentation subtest has poor reliability, its inclusion in scar assessment should be questioned. Results indicate that only total scores of the MVSS should be used when determining burn scar outcomes because individual subtest scores appear to have little reliability. Further modifications to the MVSS followed by additional research with greater numbers of subjects are warranted.
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The vast majority of clinical and basic science research on the immune consequences of burn injury and sepsis conducted during the last three decades has focused mainly on the roles of macrophages, neutrophils and, to a lesser extent, conventional T lymphocytes. During recent years, however, it has become increasingly clear that minor subsets of innate immune cells, innate regulatory lymphocytes in particular, are central to processes involved in both protective immunity and immunopathology. ⋯ Given their emerging importance and documented upstream regulatory capacities over macrophage, dendritic cell, and T lymphocyte functions, innate regulatory lymphocytes represent attractive new targets for therapeutic intervention for the overall immune paralysis that occurs with injury and sepsis. Here, we provide an overview of the current state of knowledge of these particular cell subsets in the immune response to burn injury and sepsis.