Journal of burn care & research : official publication of the American Burn Association
-
Improved markers of resuscitation are needed in patients with severe burn injuries. In previous animal and human work, we showed 1) wound hypoperfusion plays a role in burn depth progression, 2) that there are periods of repetitive ischemia and reperfusion which correlate closely to wound hypoperfusion, and 3) that wound and splanchnic bed CO2 measurements are dependent on the adequacy of resuscitation. We and others believe that current markers for resuscitation, urine output (U/O), and mean arterial pressure (MAP), lag behind in reflecting wound perfusion. ⋯ These changes preceded changes in U/O, MAP, and lactate. Although U/O, MAP, and serum lactate reflect changes in burn wound perfusion, they lag behind other markers. Tissue pH and CO2 and gastric CO2 seem to be more timely related to changes in actual burn perfusion.
-
Obesity may contribute to the functional decline in elderly adults. It can also increase the risk of mortality in burn patients. However, little data exist regarding the relationship between obesity and functional outcomes in patients with burns. ⋯ Older patients (>72.5 years) with burns less than 22.50% TBSA and a larger BMI (>31.25) had lower transfer FIM scores when compared with matched patients with a smaller BMI (< or =31.25). Among patients with greater than 22.50 TBSA burn, women demonstrated lower FIM transfer and locomotion scores when compared with men. BMI may contribute to lower functional scores and the likelihood of discharge to an inpatient setting in elderly patients with less severe burns.
-
To demonstrate the research potential of the National Burn Repository, we examined outcomes affecting the obese burn population, specifically length of stay and mortality. This retrospective analysis evaluates burn patients from the repository coded as "obese." We queried admissions from burn units between the years 2000 to 2006 (n = 101,450). We initially intended to associate and stratify obesity with several complications and outcomes using multivariate analysis. ⋯ The results not only highlighted obesity as a major challenge in burn care, but also identified means of improving the National Burn Repository to facilitate future nutrition research. The repository has vast potential to be a useful research tool for the dietitian. With standardization of the data dictionary and the addition of nutrition-related fields, such as height and weight, future research will be greatly enhanced.
-
Adequate nutritional support after thermal burn injury is essential for achieving successful patient outcomes. Dysphagia is common in burn patients. Our objective was to analyze hospitalized burn patients referred to speech pathology for swallowing evaluation. ⋯ A bedside assessment of swallowing performed by a speech pathologist is predictive of an abnormal modified barium swallow in burn patients. Burn patients with facial burns, inhalation injury, pneumonia, and a prolonged ICU stay are at increased risk for dysphagia. Prospective studies are necessary to determine in which patients an MBSS adds additional relevant clinical information.
-
Inhaled heparin/N-acetylcystine (AHA) has been reported to decrease mortality in children with inhalation injury. The use of AHA therapy in adult burn patients with inhalation injury has not been evaluated. We hypothesized that patients who received AHA therapy in the management of inhalation injury would have better pulmonary mechanics and better clinical outcomes than patients who did not. ⋯ Although best Pao2 was higher in treated patients during the first 72 hours, this was not a durable finding, and the best Pao2/Fio2 ratio was unaffected by treatment. Importantly, the use of AHA in adults with inhalation injury did not affect clinical outcomes. A prospective, randomized trial would be of benefit to delineate the clinical benefits of AHA treatment for inhalation injury.