Journal of burn care & research : official publication of the American Burn Association
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Controversy has continued regarding the practicality and accuracy of the Parkland burn formula since its introduction over 35 years ago. The best guide for adequacy of resuscitation is urine output (UOP) per hour. A retrospective study of patients resuscitated with the Parkland formula was conducted to determine the accuracy (calculated vs. actual volume) based on UOP. ⋯ Emphasis should be placed not on calculated formula volumes, as these should represent the initial resuscitation volume only, but instead on parameters used to guide resuscitation. The Parkland formula only represents a resuscitation "starting" point. The UOP is the important parameter.
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Silver has been widely used as an antimicrobial agent in burn wound care. A number of dressings containing silver have been developed using textiles, polyurethane films, foams, hydrogels, and hydrocolloids. However, biological-derived wound dressings have been advocated for their ability to more effectively promote healing and regulation of evaporation and exudation at the wound site. ⋯ The total fluid handling capacity of the silver-impregnated amniotic membrane dressing examined ranged from 4 to 6.6 g/10 cm2 in 24 to 96 hours. The silver-impregnated amniotic membranes also provided an effective barrier to bacterial penetration. The study has demonstrated the ability of silver-impregnated amniotic membrane to combat microbial infection and its ideal physical characteristics for clinical use as a burn wound dressing.
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The mechanism of monocyte deactivation in critically injured burn patients remains unresolved. Two functionally distinct F4/80+Gr-1+ and F4/80+Gr-1- monocyte subsets have been characterized based on their homing to inflammatory or noninflammatory tissues, respectively. We hypothesized that the posttraumatic milieu in the bone marrow (BM) blunts the production of "inflammatory" monocytes. ⋯ DC development from ER-MP20 progenitors and LPS-stimulated tumor necrosis factor alpha production were impaired. Therefore, BM progenitor derived MØ will replace the transient hyper-responsive circulating monocytes later during the course of the septic insult. Hypo-reactivity of the developing monocytes and DC in the BM and their subsequent egress to the periphery provide a plausible explanation for the immunosuppression that ensues a critical burn injury and sepsis.